A partnership approach to delivering technology-assisted home-based care to patients with chronic respiratory disease

Vikas Wadhwa, Clinical Director Integrated Services, Eastern Health

Rob Sutherland, Principal and Business Lead,ZEST Health Strategies

• Economic impact of Chronic

Obstructive Pulmonary Disease

in 2008: $98 billion

Chronic Respiratory Diseases Hospital Admission Risk

Programs (HARP)

• Second leading cause of

avoidable hospital

admissions in Australia

• Promote independence

• Reduce risks of

hospitalisation

Background

• Resource intensive

• Regular home visits by

specialist nursing teams

EASTERN HEALTH

+

TELSTRA HEALTH

+

Patient recruitment,

HARP service, Clinical

governance

Software and

Technology

Consortium to develop EMOC

ZEST HEALTH

STRATEGIES

+

SYMBION HOSPITALS

Collaboration, Expertise Service development &

redesign, Research &

Evaluation

Patient 1

Case Study

Patient 2

-Age 37, smoker

-Asthma preventer, occasional ventolin

-2 hospitalisations previous 12 months, ICU

-HARP Respiratory Case Management

-Respiratory Connect home Project

Case Study

Study design and

methodology

1. Reduce frequency of respiratory-related hospital readmissions/ED presentations

2. Improve patient adherence to care plan tasks

3. Reduce average no. of home visits

4. Reduce overall cost of home-based care & support

Study Design

▪ 12 month trial: Aug 2018- Aug 2019

▪ Quasi-experimental

:

Objectives

7

The App

1. Cross Platform (iOS & Android)

2. BYOD or provisioned devices

3. Zero rated data for Telstra

customers

4. TGA approved Bluetooth devices

5. SaaS model

Technology

1. Task reminders

2. Health Questionnaires/Surveys

3. Biometric data – Bluetooth and/or

manual data entry

4. Medication reminders – AMT

integration

5. Triage dashboard

Functionality

Co-design and change management

• Change management and implementation support tailored to the local health service context

Our approach:

✓ Shared governance model

✓ Co-design with the clinical team

✓ Process and patient journey mapping

✓ How-to-guides for patients and HARP staff

✓ Customisation of the technology (alerts for symptoms, Sp02)

• 77% female (n=61)

• Mean Age 65 years

• Age Range 21-96

• 23% male (n=18)

• Mean Age 65 years

• Age Range 20-85

Number of patients

Demographics

Principle referral source

• Acute Hospital (72%)

• Respiratory OPD (13%)

• Other (15%)

Eastern

Health• n=79

10

11

53%

34%

57%66%

34%

Enhanced model of care: Preliminary Outcomes

>1 avoided ED

presentations/ month

Healthcare

Utilisation

15 Avoided ED presentations

87%

Tasks completed as scheduled

Care Plan

Adherence Direct Cost Savings

>$23 000 Average cost of avoided events

Return on Investment

42% Dollars saved in avoided events:

Dollars Invested in technology

Enhanced model of care: Patient experience

Self-management of

respiratory condition Health service-seeking

behaviours

Patient perceptions

of care

“I feel more

comfortable as I know

the [nurses] are

looking at my

readings… that gives

me confidence”

“Sometimes when you’re not

well you doubt yourself. Many

times I’ve been sick and should

have called an ambulance and

haven’t... with the technology if

you get bad someone will ring

and say you need to get an

ambulance. Being told like this

means I’ll do it.”

“You can see the days

you're abnormal and normal...

that's helpful as I could look back

and say, Wednesday, Thursday,

Friday my readings were

abnormal, but this week it’s all

good. What have I done

differently this week to last

week?”

Patient 1

-Action plan, GP visit organised

-Only 1 respiratory presentation to ED 7 months; nil

admissions

-Reduction of carer stress

-Reduced anxiety

-Better recognition of symptoms and proactive in care

Case Study - Outcome

Patient 2

-No further ED presentations or admissions

-Reduced Ventolin

-Return to work fulltime whilst being monitored

-Activated Asthma Action Plan with Telephone Review

initiated through Telehealth Data

-Anxiety relieved

Case Study - Outcome

Learnings and future directions

Change management Software

Optimisation

Bluetooth pairing,

PRN medications,

further device

integration

Smartphone Access

Scaling Up

Hospital In The Home, Diabetes Palliative Care, Cardiology

EMR/PAS Integration

17

Eastern

Health

Acknowledgements

Suzanne Morony Rob Sutherland

Nicola Man

Sue Sinclair

Frank Thien

Mary WestVikas Wadhwa

Dean Martin

Tracey Hart William Grant

Ryder Manson

Vickie Irving

Jim Darcy

Zoltan Kokai

ZEST Telstra

Health

Symbion