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S. Goyal

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  • OS29 - e-Health Solutions for Patient Self Management (ID 47)

    • Event: e-Health 2018 Virtual Meeting
    • Type: Oral Session
    • Track: Clinical Delivery
    • Presentations: 1
    • OS29.03 - Personalized Chronic Disease Management: Balancing Apps and Health Coaching (ID 369)

      S. Goyal, University Health Network; Toronto/CA

      • Abstract
      • Slides

      Purpose/Objectives: Medically complex patients with co-existing conditions often receive conflicting clinical advice, hindering their abilities to appropriately self-manage multiple chronic conditions (MCC), resulting in frequent hospitalizations, premature admissions to long-term care, and a decreased quality of life. The aim of this demonstration project was to iteratively evaluate the impact of a patient-centered mobile remote patient monitoring (RPM) system, coupled with health coaching, on the experience of care, health outcomes, frequency of hospitalizations, and overall well-being of patients with MCC. The RPM system specifically enabled patients with MCCs (i.e., heart failure, chronic obtrusive pulmonary disease, chronic kidney disease, and/or diabetes) to track and monitor their own biometric data and patient reported outcomes, triggering appropriate self-care instructions and social supports. The alerts generated were also remotely monitored by a nurse and health coach; the nurse monitored intervened when appropriate, and the health coach promoted self-management and healthy behaviour change through the empowerment approach. Together, the nurse and health coach collaborated and facilitated social support for the patients. The three key priorities of this project were to 1) improve the patient experience, 2) improve health outcomes, and 3) reduce avoidable hospitalizations and emergency room visits.

      Methodology/Approach: The demonstration project had a rolling recruitment of patients who were diagnosed with heart failure, chronic obtrusive pulmonary disease, and/or diabetes. Once enrolled, patients visited the health coach at the clinical site to be on-boarded into the study, receive training on the RPM platform, and complete the study activities, such as study questionnaires and blood tests. The patients were enrolled in the program for a duration of 6 months. The project team developed a health coaching protocol that was adapted based on the needs expressed by the patient, moving towards a highly personalized health coaching protocol.

      Finding/Results: Over the 6-month period, we recruited 40 patients who had one or more of the following: heart failure, chronic obtrusive pulmonary disease, and/or diabetes. In addition to clinical outcomes, we collected analytics around both the usage of the mobile apps and the individualized health coaching delivered to each patient, and conducted 31 semi-structured interviews with patients. Preliminary analysis suggests that the preferred ratio of technology to health coaching was highly variable among participants, however technology assisted delivery of health coaching had high acceptability and perceived effectiveness among patients.

      Conclusion/Implications/Recommendations: While the benefits of remote patient monitoring for complex patients in specialty clinics have been demonstrated, there remains a gap in the support these patients receive prior to the escalation of their condition. This project demonstrated that these patients valued the ongoing support of a health coach in conjunction with remote patient monitoring, and that the ratio of the technology and coaching vary greatly on the individual’s needs and their unique psychosocial complexities. The next generation of mobile platforms need to consider that chronic disease management requires a blended approach, that moves away from “one-size-fits-all” concept, and towards a model that is able to titrate the ratio of technology and customized support based on individual needs.

      140 Character Summary: Complex patients in primary care valued the combination of digital remote patient monitoring and highly individualized health coaching for the management of MCCs.

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  • PS01 - Leveraging New Innovation Pipelines (ID 5)

    • Event: e-Health 2018 Virtual Meeting
    • Type: Panel Session
    • Track: Executive
    • Presentations: 1
    • PS01.02 - An Innovative Model for Patient-Centred Population Health Management in Ontario (ID 555)

      S. Goyal, University Health Network; Toronto/CA

      • Abstract

      M. Chang1, S. Isaacksz1, S. Goyal2, R. Wilson3; 1University Health Network, M5G 2C2 - Toronto/CA, 2University Health Network, M5G2C4 - Toronto/CA, 3Ontario Telemedicine Network, M3B0A2 - Toronto/CA