Health Problem and Characteristics of the Application Renewing Health: MAST seminar Berlin 5 May...

Health Problem and Characteristics of the Application

Renewing Health: MAST seminar Berlin 5 May 2010

Josep RocaHospital Clinic.IDIBAPS.University of Barcelona

[email protected]

TOPICS

CLINICAL & HEALTH ISSUES

TECHNICAL ISSUES

THE APPLICATION

Assessing Technology ?

Assessing Health Services supported by Technology ?

Health care & ICT

Health Service

Technological application


• Rationale• Hypothesis• Aims • Target patients• Study design • Type of intervention • Inclusion criteria• Exclusion criteria• Dimensions to be evaluated

• Clinical dimension•Technical dimension•Organisational dimension•Economic assessment

Well-being and rehabilitation programme

Rationale

• REHAB PROGRAMS INCLUDING MUSCLE TRAINING are highly recommended by all clinical guidelines for highly prevalent chronic diseases

• SUSTAINABILITY OF TRAINING EFFECTS IN A COST-EFFICIENT MANNER IS AN UNMET NEED PRECLUDING ADOPTION OF GUIDELINES


Hypothesis

• A standardised self-management program, including muscle training, can be carried out outside the hospital setting and is organisationally and economically sustainable in a long-term perspective.

• This program brings about positive outcomes in: improved quality of life, physical functioning, copying in everyday-life, reduced hospitalisation and readmissions for patients, reduce costs

• The rehab program makes it possible to sustain in the long-term the physiological benefits in muscular training.

• ICT solution favour better sustainability and patient / professional acceptability

• The characteristics of the program can be easily transferred to other chronic conditions that benefit from physical training programs


Aims

• Assess the deployment, efficiency and sustainability of a rehabilitation program supported by ICT in clinical stable patients with chronic disease

• Evaluate the effect of an integrated care pathway (combining structured patient education programme, physical exercise and planned follow-up) on quality of life, functional capacity, coping and need of health services and evaluation of the participants` experiences in the project

• Examine the effects (clinical, organisational, costs) when a standard supervised training period is followed by ICT supported monitoring over a period of 6 months and compare the results with a group followed by usual care (ICT monitoring is not used)


Target patients

Patients to be enrolled in each of the study locations are those with one or more of the following conditions: COPD, HF and coronary disease, older than the age of 45. Recruitment will take place at primary care and hospital outpatient clinics.

Study design

Randomised controlled trial on individual basis (individual RCT, ratio 1:1) with 2 arms:

• Control group with standard supervised training followed by usual care.

• Standard supervised training in combination with patient education and followed by ICT support / communication.


Type of intervention

A standardized self- management education and physical exercise programme will be conducted. The programme will be generic (not diagnosis specific) and group-based. Focus will be on coping in everyday-life with a chronic disease.

The main components will be:

Use of ICT to support the follow-up period after the completion of the standard training sessions to: promote the carrying out of the training plan and facilitate self-monitoring and reporting.

Empowering patients in the use of ICT solutions that support the follow-up period.


• Rationale• Hypothesis• Aims • Target patients• Study design • Type of intervention • Inclusion criteria• Exclusion criteria• Dimensions to be evaluated

• Clinical dimension•Technical dimension•Organisational dimension•Economic assessment

Variable Instrument Source / time

ER Visits (Hospital) DB registers TB, TM, TE

ER Visits (Primary care) DB registers TB, TM, TE

Hospital readmission rate (non-scheduled) DB registers TB, TM, TE

*LOS DB registers

HRQL (general) SF-36 TB, TM, TE

HRQL (specific COPD) SGRQ TB, TS, TM, TE

HRQL (specific HF) MacNew TB, TS, TM, TE

Frailty assessment CFS and NEadlS TB, TM, TE

**Health profile of the patient Clinical notes TB, TM, TE

6MWT (6 minute walking test) Test TB, TS, TM, TE

TB Basal assessment

TS Assessment after supervised training period

TM TS + 6 months

TE TS + 12 months

•* LOS: Length of stay•** Health profile of the patient. Under this heading, we make reference to a set of different data that is available from different databases and applications. This includes the following items: a) demographics, social economic status, urban/rural area; b) risk factors for exacerbation; c) other frailty factors, such as co-morbid conditions, anxiety-depression, educational level, economic status and caregiver support; and, d) treatment, including compliance, observed skills for administration of therapy and physical activity.


Clinical variables

TOPICS


TECHNICAL ISSUES

THE APPLICATION


Technological aspects

EHR functionality: Information sharing/exchange of information among professionals (including data on prescription).

CSCW functionality: Capabilities for coordinating professional work in the context of the specific process / programme of services. Also, general tools for professionals work (such as chat or messaging facilities).

CRM functionality: Facilitated access to the health-social services and professionals, typically through a single reference point (call-centre or alike).

E-education functionality: Education and training for professionals and patients.Mobile devices interface and tools: Utilities that enhance patient participation in the

process. This includes making easy the access to information that is relevant for the patient according to his/her condition but also resources that assist the patient to record data on the condition (questionnaires, sensors).

The results of the evaluation of the technology obtained in the different studies will be tracked to this functional level to provide a perspective that could be useful and applicable at different environments irrespective of the specific context.

PatientSupportcenter

pro

vid

ers

net

wo

rk

Overall Scenario

• Triage• Self-management• Remote monitoring

• Target patients • Management by programs• Well standardized interventions• Patient-centered care

Personal Health Folder

Technological platform: functionalities

Nurse’s portable unit

Call-Centre

Patient management unit

Home monitoring

Educational material

Home rehabilitation

Tele-working tools

Wireless mobile system

Patient’s application

The messages

Professional applications: Case Manager Dashboard

Professional’s application. Data

Usability

0

10

20

30

40

50

60

70

80

TOPICS


TECHNICAL ISSUES

THE APPLICATION

LOCAL INTEGRATION

Deployment at Barcelona Esquerra

INTEROPERABILITY AMONG PROVIDERS

• Level A - Barcelona – Esquerra• Level B - Spain and Europe

Patient summary record and electronic prescription

EAPsICSEAPsCAPSE

EAP Gesclínic

EAP Les Hortes

EAPsVallplasaHospital Clínic

Hospital SagratCor

Clínica Plató

CAP II Manso (ICS)

CAP II Numància(ICS)

EAPsICSEAPsCAPSE

EAP Gesclínic

EAP Les Hortes


Hospital SagratCor

Clínica Plató

CAP II Manso (ICS)

CAP II Numància(ICS)

EAPsICSEAPsCAPSE

EAP Gesclínic

EAP Les Hortes


Hospital SagratCor

Clínica Plató

CAP II Manso (ICS)

CAP II Numància(ICS) 3D3G

3A

2A

2C4A

2D

2E4B

5C4C

3E

5D

3C

3B

2B

5A5B

5E

3D3G

3A

2A

2C4A

2D

2E4B

5C4C

3E

5D

3C

3B

2B

5A5B

5E

• 540.000 habitantes

• 18 ABS y 2 CAPs II (5 empresas distintas)

• 4 Hospitales

• 1 Centro Sociosanitario principal y otros de menor dimensión

• 3 Proveedores de Salud Mental

• Servicio de Emergencias Médicas de Cataluña

BARCELONA ESQUERRA

Pro

cess

Un

its

HOSPITALCommunity Care

FamilyPhysician

Nurse

Social Worker

HomeCare

Transplant

Dementia

COPD

CHF

TerritorialHealthcare

TerritorialHealthcare

Deployment at Barcelona Esquerra 2009:

Hospitals vs territorial healthcare

Permanent Comission

TechnicalManagement

Team

TechnicalManagement

Team

Process 1

Process 2

Process 3

Process 4

Em

erge

ncie

s

Soc

ial C

are

Hea

lth T

rans

port

H

ome

Car

e

P

edia

tric

car

e

Pha

rmac

y

RedesignImplementation

& follow-up

M

enta

l hea

lth

IT

Operational Committees


Territorial Health Care Comission Barcelona Esquerra


Territorial Health Care Comission Barcelona Esquerra

Sp

ecia

lize

d C

are

Institutions representative

Current Deployment at Barcelona Esquerra

Technological challenge

Organizational challenge

Initial questions

1. What kind of information should be included in a description of the health problem (patients) and characteristics of the telemedicine application in MAST (section 6.1. p. 14 in the Manual)?

2. How can interoperability of a telemedicine application be described?

3. Examples of descriptions of health problems and telemedicine applications in literature (p. 48 in the Manual)?

4. How can data be collected?

5. How can the information in this domain be used to select the relevant outcomes in the other domains?

6. What is your experience with description of these aspects of telemedicine in the literature?

7. Other hints to those planning to start an assessment of a telemedicine application?

Health Problem and Characteristics of the Application Renewing Health: MAST seminar Berlin 5 May...

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