Elizabeth Krupinski, PhD 1 , Hans Roehrig, PhD 1 Toshihiko Furukawa, PhD 2 , Kazuhiro Sato, BEE 3
Elizabeth A. Krupinski, PhD Arizona Telemedicine Program.
-
Upload
donna-dorman -
Category
Documents
-
view
227 -
download
0
Transcript of Elizabeth A. Krupinski, PhD Arizona Telemedicine Program.
Recipe for Success: Skill Sets Home TH◦Leadership Potential EquationCriteria Definition
Emotional Stability Tolerate stress & frustration, well adjusted, psychologically mature
Dominance Assertive, competitive, decisive
Enthusiasm Optimistic, energetic, flexible
Conscientious Self-disciplined/motivated, high standards excellence
Social boldness Spontaneous risk takers
Tough mindedness Practical, logical, to-the-point
Self-assurance Self-confident, resilient
Compulsiveness Socially aware, careful, abundant foresight
Recipe for Success: Skill Sets Home TH◦5-Factor Personality ModelFactor Definition
Conscientiousness Extent to which hard-working, organized, dependable
Emotional Stability Degree calm, cool, self-confident
Extraversion Extent assertive, positively interacts with others
Openness Creative & curious
Agreeableness Degree cooperative & warm to co-workers
Recipe for Success: Skill Sets Home TH◦VA Skill SetsCriteria Critical Ingredients
Skill Sets Clinical assessment, critical thinking, scientific process, communication, negotiation, collaboration, conflict resolution
Core Knowledge Organizational structure, community resources, team building, service delivery, psychosocial support
Personality Traits Flexible, adaptable, optimistic, resourceful, self-motivated, persistent, intuitive, advocate, leader, compassionate
Technical feasibility Provider & patient acceptance/satisfaction
Cost effectiveness Outcomes = equivalent or better than traditional
H.R. 6331. = 1/1/09, skilled nursing facilities, in-hospital dialysis centers & community mental health centers = originating sites for Medicare reimburse
COPD HH vs TN◦Pare et al. 2006◦7.5 vs 4.2 home visits 46.6 min vs 57.5 min
◦40% vs 5% hospitalizations 7.3 days vs 13.5 days
◦$2,779 vs $2,424 per patient over 6 mo
◦Attitudes overall positive
Diabetes◦Chumbler et al. 2005 with VA◦Pre vs post TH enrolment◦50% reduction hospitalizations◦11% reduction ER use◦3.0 fewer bed days of care◦Overall improvement QOL, pain reduction & social functioning
◦Other studies show HbA1C improvement
Acute infections Chronic respiratory failure Lung transplant recipients Stroke recovery Asthma self-management Cystic fibrosis Chronic heart failure Spinal cord injury PTSD & TBI Mental disabilities (schizophrenia,
Alzheimer’s) Pediatric, adult & geriatric populations
Cancer patients with ostomies being discharged earlier after surgery
Reduces time proficient in self-care Increases need for education & support visits by nurses after discharge
Distance & time can be considerable Shortage of nurses specializing in ostomy care
Achieving self-care is a process Nurses guide patients from dependence to independence
Start with total care & conclude with education & support
Telemedicine can serve a role in this process at all stages
28 patients with ostomies resulting from treatment for cancer◦14 HH =11 urostomy, 3 colostomy◦14 TH/HH = 7 urostomy, 7 colostomy◦LOS = 8.86 days HH; 8.36 days TH◦68% male, 32% female◦Mean age = 66.5 yrs (sd = 9.68)◦89% Caucasian, 7% Hispanic, 4% AfAm
HH TH
Bladder Cancer (64%) 1 7
Colorectal Cancer (28%) 3 5
Cervical/Ovarian Cancer (8%)
0 2
HH TH
Spouse (78%) 11 11
Daughter (11%)
2 1
Sister (4%) 1 0
Brother (3.5%)
0 1
Parent (3.5%) 0 1
HH TH
Education
Some College (55%) 8 8
Some High School (26%) 3 4
Grade School (19%) 3 2
Marital Status
Married (77%) 11 11
Widowed (4%) 1 0
Divorced (4%) 1 0
Never Married (14%) 1 3
Religion
Protestant (39%) 6 5
Catholic (25%) 4 3
Other (11%) 1 2
No Affiliation (25%) 3 4
No significant differences
Mean SD Range
HH 6.29 4.25 1 – 17
TH FTF 5.43 3.03 1 – 13
TH 3.57 1.28 2 - 6
Surgery: t = 0.304, p = 0.7632 Discharge: t = 0.170, p = 0.8666
Mean SD
HH Surgery 15.07 days 8.42
HH Discharge
6.79 days 7.49
TH Surgery 13.71 days 14.39
TH Discharge
6.14 days 12.04
Ostomy surgery explained = 100% Enterostromal nurse participated care =
96% Family of support during surgery = 100% Received United Ostomy Association
visitor during hospital stay = 38% Who helped adjust to surgery
◦Family = 36%◦Ostomy nurse = 36%◦Doctor or nurse = 22%◦Other = 6%
Agree HH
Agree Both
DisagreeHH
DisagreeBoth
NeutralHH
Neutral Both
Future hopeless 0% 15% 91% 77% 9% 8%
Take care self 70% 77% 30% 15% 0% 8%
Easily talk @ ostomy 100% 92% 0% 8% 0% 0%
Feel helpless 18% 8% 82% 84% 0% 8%
Activity limited 36% 38% 64% 62% 0% 0%
Feel angry 28% 30% 63% 62% 9% 8%
Prevents relationships
28% 24% 72% 76% 0% 0%
Odor 18% 31% 73% 61% 9% 8%
Look at stoma without depressed
82% 84% 18% 16% 0% 0%
Colostomy Significantly > Urostomy
Agree HH
Agree Both
DisagreeHH
DisagreeBoth
NeutralHH
Neutral Both
Dress same clothes 72% 54% 19% 38% 9% 8%
Avoid situations now 18% 34% 64% 66% 18% 0%
Ostomy is a disability 45% 38% 54% 55% 0% 8%
Travel is no problem 81% 77% 10% 8% 9% 15%
Physically active 45% 54% 55% 38% 0% 8%
Socially active 72% 62% 28% 30% 0% 8%
Sexually active 30% 18% 70% 82% 0% 0%
Sex relationship worse 55% 54% 45% 37% 0% 9%
Would visit other ostomy patients
45% 62% 28% 23% 27% 15%
HH TH Sig
Nurse understands problem
11% disagree 0% disagree
X2 p < 0.01
Comfortable with what nurse said about ostomy
11% disagree 0% disagree
X2 p < 0.01
Overall satisfaction 81% satisfied 93% satisfied
NS
Camera embarrassed
15% agree
TH care more accessible
100% agree
Prefer TH instead of waiting
87% agree
Prefer FTF 70% agree
TH as good as FTF 85% agree
HH TH
A) Mean # visits 6.29 5.43/3.57
B) Mean cost nursing visits $63 salary* + 0.34/mile
@ 12 miles
HH = sameTH =
$18.90**
C) Average cost pouches used $123.22/pt $70.73/pt
D) Final cost (A x B) $444.52 $377.31 HH$67.50 TH***
$444.81 total*Set fee for HH visit
**30 min 0.04/min airtime = $1.20 + $17.70 salary*** TH only vs HH t = 5.05 p = 0.0001
Sutter Health eICU (CA; Teresa Rincon)◦Onsite intensivist coverage 12 hrs/day = $43,810
◦RN resource for APACHE & se[sis data collection = $11,700
◦Licensing fees for risk adjusted data collection = $1800
◦Total costs per bed onsite = $57,310◦Total costs per bed eICU = $42,000
Remote monitoring & wearable devices
Wellness & prevention devices Call-centers & automatic monitoring Smart homes Business-based programs All have TH Nursing component Need to be evaluated further for impact & health outcomes
Telenursing occurs on a variety of levels & in many environments
Clear cost & outcome benefits have been demonstrated
Opening avenues for reimbursement & new care settings
Providers & patients will continue to benefit from telenursing expansion