IT for Chronic Illness Management in the Home

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IT for Chronic Illness Management in the Home

• Betty Levine, Division Director
• eHealth Telemedicine

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Good Old Days

• Generalist physician was fully in charge of the
  patient
• He/she had no access to information or technology
• He/she often practiced away from an office or
  clinic

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Benefits of Health IT

• Improve access to doctors, information, and
  support
• Improve quality as measured by better clinical
  outcomes
• Reduce overall cost of care

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Chronic Illnesses Management in the Home 2
Studies

• MindmyHeartTM - Home monitoring and case
  management of Congestive Heart Failure patients
• MyCareTeamTM - Self-management and remote
  monitoring of Diabetes patients

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Congestive Heart Failure

• Affects nearly 5 million Americans
• About 500,000 new cases each year
• Hospitalizations results in 7.5 billion in
  medical expenditures each year
• Daily monitoring of patients weight, blood
  pressure and pulse oximetry

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MindmyHeartCHF Management

• Medicare Demonstration Project
• 118 intervention patients 116 control
• Study ran June 2002 December 2005
• Patients used home monitoring technologies
• Case managers assigned to patients
• Case managers used web technologies
• to view patients vital signs
• to mark assessments on patients
• maintain plans of care

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MindmyHeart
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MindmyHeart Results

• Clinical results being analyzed by CMS
• Cost effectiveness being analyzed by CMS
• Patient satisfaction with technology and case
  management analyzed at Georgetown

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MindmyHeart Satisfaction Study
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MindmyHeart Discussion

• Long-term use of technology is atypical
• Maintenance of equipment was an issue
• Some Patients experienced monitor fatigue
• Needed to reduce usage
• Some patients became very dependent on case
  manager and technology
• Did not become as self-sufficient or educated as
  had hoped

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Diabetes

• More than 18 Million Americans with diabetes
• 1/3 Undiagnosed
• Total (direct and indirect) cost 132 billion
• Early detection and proper treatment of diabetes
• prevent up to 90 of incidents of blindness
• reduce amputations by more than 50
• reduce kidney disease and dialysis by over 50

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MyCareTeamTMDiabetes Management

• Electronic capture and transmission of blood
  sugar readings
• Automated real-time analysis of readings
• Multiple presentation options
• Improves communication
• Educates patients using their own daily readings
• Web based and intuitive user interface

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MyCareTeamTM Technology
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MyCareTeamTM Lobby
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Initial Patient Screen
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Blood Sugar Log Book
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Blood Sugar Charts and Graphs
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Patient/Provider Comments
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Education
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MyCareTeamTM Implementations

• Completed studies
• GUMC pilot study (16 patients)
• Veterans Administration Healthcare System (104
  patients)
• Ongoing studies
• National Navy Medical Center (NNMC)
• Diabetes and pregnancy
• Sacred Breath Native Communities from
• Alabama, North Dakota, Idaho, Alaska, and Hawaii

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Boston VAResults over 12 months

• ? in HbA1c based on web-access (P
• Persistent users 1.91.2
• Intermittent users 1.21.4
• Control Group 1.21.4 (no web access)
• ? in HbA1c based on data uploads (P
• Highest tertile 2.11.1
• Lowest tertile 1.11.7
• Control Group 1.21.4 (no data uploads)
• McMahon, et al., Web-based Care Management in
  Patients with Poorly Controlled Diabetes
  Mellitus, Diabetes Care, 2005, Vol 28, 7,
  1624-1629.

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Conclusions from VA Study

• Most of the study participants had no prior
  computer experience and/or Internet Access.
• The findings support a role for web-based care
  management in patients with elevated HbA1c as a
  tool to improve diabetes care.
• Patients with poorly controlled diabetes who
  adopt such a system and regularly exchange
  information with their healthcare providers are
  likely to derive important clinical benefits.
• McMahon, et al., Web-based Care Management in
  Patients with Poorly Controlled Diabetes
  Mellitus, Diabetes Care, 2005, Vol 28, 7,
  1624-1629.

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Ongoing Studies

• NNMC enrolled 24 pregnant women with diabetes
• All are followed until they deliver
• Track blood sugar and insulin regularly and
  communicate with provider

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Ongoing Studies

• Sacred Breath - 4 of the 5 communities have
  started enrolling patients
• 70 patients enrolled to date
• Blood sugar readings sent in regularly and
  reviewed online
• Communicate with a nurse through MyCareTeam

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Objectives of Sacred Breath/NNMC

• To look at implementation of technology into
  diverse communities
• Evaluate if similar positive outcomes seen in
  these different communities
• Identify the changes necessary to make the site
  useable and useful to these diverse communities

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Lessons Learned

• Chronic Illness Management in the Home
• Is the responsibility of the patient it is a
  behavior modification issue
• Requires better tools to facilitate
  self-management
• Is possible since the Internet permits ubiquitous
  access to ones medical record to encourage
  behavior modification
• Must be sustainable outside of research studies
  to succeed
• Needs to balance provider support of the patient
  with the patients self management