Home Telehealth: Enhancing Access to MS Health Care

Transcription

1 Home Telehealth: Enhancing Access to MS Health Care Jodie K. Haselkorn, MD, MPH Director, MS Center of Excellence West Professor, Rehabilitation Medicine Adjunct Professor, Epidemiology University of Washington PVA Summit Orlando 2013

2 No Disclosures

3 Objectives Describe the development of Care Coordination and Home Telehealth in the Veterans Health Administration Discuss MS Home Telehealth Disease Management Protocol

4 Investment in Resources and Processes 2011 Budget $80.5 million 2012 Budget $105 million Standardized training in home telehealth Expanded development of evidence-based disease management protocols Performance plan incentives for VISN and medical center executives

5 Features of National Telehealth Infrastructure Conditions of participation for Vendors Blanket purchase agreements Centralized handling of equipment Codified procedures Credentialing and privileging Centralized scheduling Quality control and risk management Systematic collection and analysis of outcomes

6 Three Telehealth Training Centers: Sunshine Training Center: Home Telehealth Staff Training through Asynchronous and Synchronous Modalities Lead Care Coordinators & Care Coordinators Program Support Assistants & IT Support VISN Telehealth Leads and Leadership Master & Support Preceptors Telehealth Clinical Technicians Facility Telehealth Coordinators Best Practice Training Lessons from the Masters: Disease Specific Care Advancing Home Telehealth Practice Home Telehealth Annual Competency program Home Telehealth Clinical Community of Practice Innovations and Advancements in Technology

7 Home Telehealth Census FY ,000 92,000 80,000 66,000 60,000 40,000 35,406 40,348 48,345 20,000 0 FY08 FY09 FY10 FY11 FY12

8 Mission: High quality, consistent care to veterans regardless of where they are located geographically. Implement Wagner s Chronic Care Model using and enhancing the VA s informatics backbone.

9 MSCoE Telehealth and Chronic Care Model Self Management Support MS Disease Management Protocol Delivery System Design Provide health services at the right time and right place, in the home Reduce unscheduled visits and hospitalizations Information System Evaluate with ProClarity and VA MS National Data Repository Decision Support and community links Connect to MSCoE using My HealtheVet and secure messaging Link with Care Coordination and Home Telehealth and provider when necessary

10 MSCoE Telehealth Goals Veteran and Caregiver Increase access to specialty care Reduce the burden of Veteran and caregiver travel Provide in-home support to delay or prevent longterm institutional care Help reduce wait times Organization Deliver appropriate services to a population of Veterans with MS Decrease non-scheduled visits and phone calls Decrease transportation costs Provide alternatives to long-term institutional care

11 VA Puget Sound HCS WA Portland VAMC OR NV CA 22 Los Angeles VAMC Long Beach VAMC Sacramento Mather VAMC San Francisco VAMC MT ID WY 19 VA Salt Lake City HCS UT CO AZ 18 NM Carl T. Hayden VAMC ND SD Rapid City VAMC NE Eastern Colorado HCS TX KS Oklahoma City VAMC OK MN Minneapolis VAMC 23 Iowa City VAMC 15 IA MO Little Rock VA HCS 16 AR VA North Texas HCS LA WI 12 Madison VAMC IL MS IN MI Jesse Brown VAMC Edward Hines Jr. VAMC St. Louis VAMC TN Memphis VAMC AL 11 KY OH Birmingham VAMC Detroit VAMC Indianapolis VAMC 9 GA GV (Sonny) Montgomery VAMC Syracuse VAMC Buffalo VAMC Cleveland VAMC 10 7 WV PA SC 5 VA NC NY MD VT NJ 3 NH Albany VAMC ME 1 MA CT RI VA Boston HCS West Haven VAMC NY Harbor VAMC Philadelphia VAMC DE Baltimore VAMC Washington DC VAMC Richmond VAMC Ralph H. Johnson VAMC AK New Orleans VAMC Tampa VAMC FL 8 MSCoE Coordinating Center Miami VAMC 21 HI MSCoE East Regional Hub Site MSCoE West Regional Hub Site VISN

12 Anchorage Seattle 2,266 miles driving 1,444 miles flying

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15 Care Coordination & Home Telehealth MS Disease Management Protocol (DMP) Vital Signs MS Symptom Monitoring Medication Persistence Secondary Symptom Monitoring Depression, Fatigue, Pain, Spasticity, Bladder, and Bowel Disease Management Education and Strategies Care Partner Support

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18 Home Telehealth and Disease Management Pilot Observational Cohort Veterans (n=41) VA Puget Sound Healthcare and Washington DC VA 66% participated with 8-33 weekly questions for 6 months; 85% for 5 months

19 Characteristics of Participants Age, mean (SD) 52.6 (8.7) years Gender (male) 80.5% White 68.3 % Married 67.5% Employed 20.0% Duration of MS mean (SD) (10.72) years EDSS score, mean (range) 6.5 (2 8.5) Relapsing remitting 17.9% Secondary progressive 59.0% Primary progressive 23.1% DMT 61%

20 Characteristics of Participants Drive 42.5% Driven by someone else 35.0 % Distance mean (max) Travel time mean (SD) (351.37) miles 71.8 (68.6) minutes Endorsed symptoms at baseline: fatigue (95%), depression (78%) and pain (71%)

21 Change in Percent Reporting Symptoms Months 1 and 6 Month 1 6 Change Neurologic Pain Fatigue Bladder Bowel Depression DMT side effects DMT missed doses

22 Outcomes Easy to understand 93.8% Easy to use 93.8% Worked like it is supposed to 75.0% Worked when needed 87.6% Satisfaction 87.5% Improved care 62.5% Would prefer home telehealth 50.0%

23 Themes from Care Partners Increases competent care Extends time at home Decreases care partner depression and fatigue Allows for more personal time and less travel Turner AP, Wallin, MT, Sloan A, Maloni H, Kane R, Martz L, Haselkorn JK. Clinical management of MS through home telehealth: Results of a pilot. Int J of MS Care, in press.

24 Cost Outcomes with Home Telehealth Reduced bed days of care 50% Lowered rates of institutional placement Reduced fee basis care Reduced clinician travel Reduced payment for Veteran travel

25 Disease Management Protocol MS National Roll-out Pilot in 2 regions of the county Revised Disease Management Protocol Re-pilot Vendor implementation FY 2014 MSCoE developing educational support for Care Coordination and Home Telehealth Nurses

26 CCHT Disease Management Protocol System Examples Example: Home Telehealth Monitor Patient data responses load in CPRS to help monitor clinical care Example: Home Telehealth Monitor Example: Answers to MS questions with color-coded alerts on CPRS Example: MS education message to increase patient self-care 26