Health Problem and Characteristics of the Application

Renewing Health: MAST seminar

Berlin 5 May 2010

Josep Roca

Hospital Clinic.IDIBAPS.University of Barcelona [email protected]

TOPICS

CLINICAL & HEALTH ISSUES THE APPLICATION TECHNICAL ISSUES

Assessing Technology ?

Assessing Health Services supported by Technology ?

Health care & ICT

Health Service Technological application

CLINICAL & HEALTH ISSUES

• 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

Well-being and rehabilitation programme 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

Well-being and rehabilitation programme

• • •

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)

Well-being and rehabilitation programme 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.

Well-being and rehabilitation programme 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.

CLINICAL & HEALTH ISSUES

• 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 Clinical variables Variable

ER Visits (Hospital) ER Visits (Primary care) Hospital readmission rate (non-scheduled) *LOS

Instrument

DB registers DB registers DB registers DB registers

Source / time

TB, TM, TE TB, TM, TE TB, TM, TE HRQL (general) HRQL (specific COPD) HRQL (specific HF) Frailty assessment **Health profile of the patient 6MWT (6 minute walking test) TB SF-36 SGRQ MacNew CFS and NEadlS Clinical notes Test Basal assessment TB, TM, TE TB, TS, TM, TE TB, TS, TM, TE TB, TM, TE TB, TM, TE TB, TS, TM, TE TS TM Assessment after supervised training period 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.

TOPICS

CLINICAL & HEALTH ISSUES THE APPLICATION TECHNICAL ISSUES

Well-being and rehabilitation programme 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.

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

Overall Scenario

Patient Personal Health Folder

• Triage • Self-management • Remote monitoring

Support center

Technological platform: functionalities

Home rehabilitation Tele-working tools Educational material Nurse’s portable unit Home monitoring Patient management unit Call-Centre

Wireless mobile system

Patient’s application

The messages

Professional applications: Case Manager Dashboard

Professional’s application. Data

Usability

80 70 60 50 40 30 20 10 0 G lo ba l u sa bi lity Effi ci en cy A ffe ct H el pfu ln es s C on tr ol Le ar na bi lity

TOPICS

CLINICAL & HEALTH ISSUES THE APPLICATION TECHNICAL ISSUES

LOCAL INTEGRATION

Deployment at Barcelona Esquerra

The Vision

INTEROPERABILITY AMONG PROVIDERS

• Level A Barcelona – Esquerra •

Level B

Spain and Europe Patient summary record and electronic prescription

BARCELONA ESQUERRA

EAPs ICS EAPsCAPSE EAP Gesclínic EAP Les Hortes EAPsVallplasa Hospital Clínic 4B 5C 3G 2B 2A 5A 2E 5B • 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

Deployment at Barcelona Esquerra 2009:

Hospitals vs territorial healthcare HOSPITAL

Community Care Transplant Dementia COPD CHF Territorial Healthcare

Family Physician Nurse Social Worker Home Care

Deployment at Barcelona Esquerra 2009:

Territorial Health Care Comission Barcelona Esquerra Institutions representative Permanent Comission

Redesign Implementation & follow-up

Technical Management Team Process 1 Process 2 Process 3 Process 4 Operational Committees

Current Deployment at Barcelona Esquerra

Main services deployed

Wellness & Rehabilitation Frailty – Transitional care – Palliative care Home hospitalisation Support

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?