Using technology to transform care for patients with Parkinson disease
MATRC Telehealth SummitMarch 18, 2013
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Disclosures
Grant fundingGrant
funding
ConsultingConsulting
StockoptionsStock
options
•Agency for Healthcare Research and Quality•Avid Radiopharmaceuticals•Google•Excellus BlueCross BlueShield•Lundbeck•Macklin Foundation•National Institute for Neurological Disorders and Stroke•Prana Biotechnology•Verizon Foundation
•Avid Radiopharmaceuticals•Clintrex•Lundbeck•Medtronic
•ConsultingMD
PatentsPatents•Pursuing a patent related to receiving care via telemedicine
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Outline
• The burden of Parkinson disease and other chronic conditions is growing, but access to care is limited
• Technology can remove geographic barriers to care
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Outline
• The burden of Parkinson disease and other chronic conditions is growing, but access to care is limited
• Technology can remove geographic barriers to care
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The burden of Parkinson disease and other neurodegenerative conditions is growingDistribution of individuals with Parkinson disease by country from 2005 to 2030*
Source: Neurology 2007;68:384-6
*Among individuals over 50 in the world’s ten most and Western Europe’s five most populous nations
2005100% = 4.1 million individuals
2030100% = 8.7 million individuals
China, 48%
Europe, 14%
China, 57%Others, 12%
Brazil, 4%
U.S. 8%
India, 8%
Europe, 20%
India, 8%
U.S. 7%
Brazil, 4%
Others, 10%
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Access to specialty care and clinical trials is geographically restricted in the US
Sources: Movement Disorders Society directory; wemove.org
*excludes NIH/NINDS, FDA, neurosurgery, and the Washington D.C. area
Distribution of Parkinson disease specialists in Maryland*
In Maryland, 20 of 23 counties do not have access to a Parkinson disease specialist
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Forty percent of Medicare beneficiaries with Parkinson disease have not seen a neurologist
Source: Courtesy of AW Willis 2012
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Access to care is even more restricted around the world
Sources: Movement Disorders Society directory; Neurology 2007;68:384-6; WHO Country Resources for Neurologic Disorders 2004 (WHO, 2004)
• In Bolivia, not one of the individuals identified with Parkinson disease had seen a physician for his or her condition
• In China, there are ~50 Parkinson disease specialists for ~2 million people with the condition
Worldwide, most people with Parkinson disease have likely not been diagnosed and most likely have not been treated
• In 40% of all countries, anti-Parkinsonian drugs are generally not available
• In 83% of low income countries, there are no available treatments for Parkinson disease
Patients who see a specialist have significantly better outcomes and survivalSix-year survival among patients with Parkinson disease
Source: Neurology 2011; 77:851-857
Patients with Parkinson disease who see a neurologist are:• 14% less likely to have a hip fracture• 21% less likely to be placed in a skilled nursing home facility• 22% less likely to die
Patients who see a neurologist
Patients who see a primary care physician
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Excellent specialty care is available and can improve outcomes for a variety of conditions
Specialists lead to higher quality care•Heart disease More appropriate medication use•Asthma Greater adherence to national management guidelines•Diabetes Better process measures
Higher quality care improves outcomes•Heart failure Increased survival
•Asthma Improved quality of life
•Diabetes Fewer complications
Model of improving outcomes
Sources: NEJM 1994;331:1136-42; Arch Int Med 1998;158:457-64; Diabetes Care 2004;27:398-406; CMAJ 2005;172:189-94; J Allergy Clin Immunol 2005;116:1307-13; Mov Disord 2007;22:515-22
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Outline
• The burden of Parkinson disease and other chronic conditions is growing, but access to care is limited
• Technology can remove geographic barriers to care
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We are using simple, inexpensive technology to reach patients around the worldTelemedicine can be used to reach people anywhere
Equipment
•Laptop or portable device•Internet connectivity•Web cam, microphone•Encrypted software
• In-home care•Remote patient monitoring•Remote study participation
Source: Dorsey ER et al. Mov Disord 2010;25:1652-9; Biglan KM, Dorsey ER, et al. Mov Disord 2009;24:1073-1076
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Telemedicine visits are similar to in-person visits in content
We completed a randomized, controlled trial of virtual housecalls for Parkinson disease
20 patients with PD at two centers
11 patients receive 3in-person visits over 6 months
9 patients receive 3 telemedicine visits over 6 months in home
Randomized
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Outcomes:
1. Feasibility 2. Clinical outcomes3. Economic value
Telemedicine
In-person
Sponsors:Source: “Randomized, controlled trial of “virtual housecalls” for Parkinson disease” (2013) JAMA Neurology. In press.
Telemedicine is a feasible means of providing care into people’s homes
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Telemedicine
Perc
ent
In-person
91%
Proportion of visits completed as scheduled
93%
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Patients in both arms had similar clinical outcomes
*Excludes assessments for rigidity and postural stability
Bet
ter
Telemedicine (n=9)
In-person care (n=11)
Change in Quality of LifePoints on PDQ-39 scaleN=20 total
+4.0
+6.4
+1.2
Telemedicine (n=9)
In-person care (n=11)
Bet
ter
+3.9
Change in Motor FunctionPoints on modified UPDRS Part III* scaleN=20 total
+1.2
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Patients in the telemedicine arm rated their quality of care higher
Telemedicine (n=4)
In-person care (n=6)
Bet
ter
Change in Quality of CarePoints on Patients Assessment of Chronic Illness Care (PACIC)N=10 total
Wo
rse
+1.4+1.5
- 3.8
Telemedicine flips the paradigm
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Patient time spent on in-person versus telemedicine visits
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Using telemedicine, we have extended our reach into homes in 5 states…
Our program has saved patients roughly 20,000 miles of travel
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…and 15 countries
Our program has saved patients over 200,000 miles of travel
With support from Verizon, we launched a free telemedicine clinic for patients with PD
Patients selected each month to
participate
Technology specialist assists in
setup
Patients receive care from PD specialist
Recommendations sent back to patients and their physician
Patients call 855.237.7666 to
request an appointment
21Source: www.hopkinsmedicine.org/pdtelemedicine
Supported by:
If you or someone you know live in MD, DE, CA, FL, or NY, and
are interested in receiving a free
consultation:
Call 855-237-7666 to enroll!
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We are just scratching the surface of what is possibleGrowth horizons
Impact
Phase 1Provide care to individuals with Parkinson disease directly in their homes (“virtual house calls”)
Phase 2Increase scale and reach of model nationally and globally
Phase 3Expand scope to other conditions (e.g., Huntington disease, ataxia)
Time
Our vision is to provide patient-centered care to individuals with
Parkinson diseaseanywhere they live
Our vision is to provide patient-centered care to individuals with
Parkinson diseaseanywhere they live
Phase 3Expand scope to other conditions (e.g. Alzheimer’s, Huntington disease, etc.)