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Effectiveness of Primary Care teleHealth Mortality & Healthcare Consumption Outcomes in Treating High-risk Chronic Conditions: The ValCRÒNIC Trial Sherman Kong, M.Sc.* BGSE (2014) * fingers crossed
Transcript
1. Effectiveness of Primary Care teleHealth Mortality &
Healthcare Consumption Outcomes in Treating High-risk Chronic
Conditions: The ValCRNIC Trial Sherman Kong, M.Sc.* BGSE (2014) *
fingers crossed
2. The Fuss
3. Prevention Coordination How It Works (and can save 99bn)
Monitoring Information
4. The Valencian Context population > 5 million in 2012
(10.6%) High density at 222 people/km2 (vs 93) 16.7% at 65 years
old + 2009: Budget of 5.5 bn 4.65 5.31 in Chronic Care
Chronic-condition patient consumption: 80% primary care
consultations 60% hospital admissions 2/3 of emergency services
Agncia Valenciana de Salut at 40% of budget and oversees 24 health
departments (34 hospitals, 6 in long-term care)
5. Enter ValCRNIC Sagunto Elche Planning began in 2011. Trial
from 2012 2013. 17mn Public-Private Partnership: Largest in EU afte
UK W.S.D. Two key interventions: Tracking and Education 2
departments Sagunto and Elche: 11 and 6 PCC, 1 and 1 hospital + SC
(250 vs 484 beds) 512 self-selected patients in high-risk profiles
:
6. The Tech
7. The Tech
8. The Tech
9. Objective & Data Central research question: Is any
indication that teleHealth intervention can produce better health
and reduce intensive acute care use? Death counts, A/E Admission
& Visits (5 Hours+), Avoidable Hopsitalization Hospital and
primary care visitation records: 12 months before and during 1024
controls (all of Valencian region) via distance matching by 4
characteristics: Logistic + ZIP Models:
10. Comparison: Demography
11. Visualize: PC Visitation GP visits Nurse visits
12. Visualize: AH Visitation
13. Compare: Before Trial
14. Compare: During Trial
15. Estimations Intense Acute Care Utilization A/E Admission
& A/E Visits of 5 Hours and Over: Binary-choice measure
Instrument for decompensation Correct duplicate counts 1|0 = having
| not having such visit type Total outpatient visits: likelihood
.996 Treatment has a similar affect (insignificant): odd ratio .990
Worst health, more visits: CRG Group 6 at 2.5x CRG Group 8-9 at
4.85x CRG Level = 1.75x Once happened, more lightly to repeat
(1.49)
16. Estimations Avoidable Hospitalization Treatment effect
counterintuitive: risk aversion? Length of Stay lowers avoidable
incidents: one admission stay, unique cases CRG remains predictable
Marginal effect for treatment: 0.061 (0.121) Mortality Trial-period
outcomes used Treatment effect insignificant but nicer Marginal
effect for treatment even less: 0.003 (0.004)
17. Limitation No device transactional data Self-assessed
health and other survey results (Zissman et. al 2012) 40 MS
patients from Carmel Medical Center, Israel had more positive
perception in health distress, cognitive function, social function
energy, emotional well-being, pain (median change greater than 5%
in 4 areas) Effect by types and intensity of interaction No time
variable for control for trend Inconsistent trial duration: minor
Lowest: 9 days only 10% less than half of 365 days Insignificant
prediction on lower intensive acute care use and death Estimate for
other utilization outcomes Survival Analysis, Diff-in-Diff,
Cost-Effectiveness Conclusion & Expansion
18. Looking Beyond: 4 Blind Spots
19. Ethnical: Quality of Care, Data Privacy / Ownership
Behavioral: Risk vs. Ambiguity Aversions, Conflict in Decision
Political: Organizational vs. Biochemical Change Economical: $ +
Short (Pilotitis), Evaluation Standards, Reg. Guidelines Looking
Beyond: 4 Blind Spots
20. Ethnical: Quality of Care, Data Privacy / Ownership
Behavioral: Risk vs. Ambiguity Aversions, Conflict in Decision
Political: Organizational vs. Biochemical Change Economical: $ +
Short (Pilotitis), Evaluation Standards, Reg. Guidelines Looking
Beyond: 4 Blind Spots Behavioral economics
21. Ethnical: Quality of Care, Data Privacy / Ownership
Behavioral: Risk vs. Ambiguity Aversions, Conflict in Decision
Political: Organizational vs. Biochemical Change Economical: $ +
Short (Pilotitis), Evaluation Standards, Reg. Guidelines Looking
Beyond: 4 Blind Spots
22. Ethnical: Quality of Care, Data Privacy / Ownership
Behavioral: Risk vs. Ambiguity Aversions, Conflict in Decision
Political: Organizational vs. Biochemical Change Economical: $ +
Short (Pilotitis), Evaluation Standards, Reg. Guidelines Looking
Beyond: 4 Blind Spots