Hospice and Home Monitoring Care at the End of Life - PowerPoint PPT Presentation

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Hospice and Home Monitoring Care at the End of Life

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Promoted physician intervention without nursing visit ... Patients perceived improvement in anxiety, physical well-being, and support ... – PowerPoint PPT presentation

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Title: Hospice and Home Monitoring Care at the End of Life


1
Hospice and Home MonitoringCare at the End of
Life
  • ATA Annual Meeting
  • September 2006
  • Roberta L. Laurie
  • Executive VP
  • VNA Hospice and Palliative Care Partners of Ohio

2
VNA HEALTHCARE PARTNERS OF OHIO
3
WHY HOSPICE HOME MONITORING?
  • VNA Home Health experience
  • Clinical Outcomes
  • Business Opportunity

4
WHY HOSPICE HOME MONITORING?
  • VNA Experience
  • Large home monitoring program
  • Structure in place
  • Positive patient and financial outcomes
  • Plan for program expansion
  • End of life patients appropriateness

5
WHY HOSPICE HOME MONITORING?
  • Clinical
  • Goal appropriate program of service and level
    of care
  • Transition for home health monitored patients
    Improve clinical outcomes related to symptom
    management
  • Enhance physician partnership
  • Reduce anxiety
  • Improve clinical service quality
  • Strengthen case management

6
WHY HOSPICE HOME MONITORING?
  • Business Opportunity
  • Competitive advantage
  • Enhance market position
  • Length of stay
  • Potential to reduce costs related to
  • Hospitalization/revocation
  • Hospice/Non-hospice medication costs
  • Nursing visits
  • Triage support

7
THE PLAN FOR IMPLEMENTING HOSPICE HOME MONITORING
  • Barriers
  • Attitudes
  • Territory
  • Cost

8
THE PLAN FOR IMPLEMENTING HOSPICE HOME MONITORING
  • Clinical Barriers
  • Determining appropriate diagnoses
  • Determining the types of patients that may
    benefit from monitoring
  • Anxiety
  • Symptom management
  • Caregiver support
  • How to transition patients from acute care to end
    of life care
  • How to educate the physicians/ community
    regarding the use of monitoring in End of Life

9
THE PLAN FOR IMPLEMENTING HOSPICE HOME MONITORING
ADDRESSING THE BARRIERS
  • Executive Approval
  • CEO
  • VP Operations
  • Other Executives
  • Largest impact
  • Quality Assurance
  • Market Changes

10
THE PLAN FOR IMPLEMENTING HOSPICE HOME MONITORING
ADDRESSING THE BARRIERS
  • Staff Education Peer Review
  • RN Palliative Care Coordinator
  • Medical Director support buy-in

11
THE PLAN FOR IMPLEMENTING HOSPICE HOME MONITORING
ADDRESSING THE BARRIERS
  • Community Education and Outreach
  • Team Meeting

12
THE PLAN FOR IMPLEMENTING HOSPICE HOME MONITORING
  • STEP I Select Vendor
  • Partner model
  • User friendliness of equipment
  • Company reputation / viability
  • Product quality
  • FDA approval

13
THE PLAN FOR IMPLEMENTING HOSPICE HOME MONITORING
STEP II -- Program Operations
  • Staff Selection
  • Policies
  • Care Delivery Model
  • Protocols
  • Tracking
  • Clinician Training
  • Troubleshooting

14
PILOT
15
EVALUATION
  • Impact on clinical care delivery
  • Financial Analysis / ROI
  • Satisfaction
  • Patient / Caregiver
  • Nurse
  • Physician

16
PRELIMINARY FINDINGS
  • Clinical Impact
  • Reduction in hospitalization
  • Qualitative findings
  • Reduction in patient/caregiver anxiety
  • Improved medication management based on monitor
    data
  • Improved symptom management
  • Promoted physician intervention without nursing
    visit
  • Strengthened nurse/physician collaboration
    related to symptom management

17
PRELIMINARY FINDINGS
  • Financial Impact
  • Decrease in visit frequency per patient day
  • No re-hospitalization in Hospice group
  • Evaluated the impact of monitoring on medication
    use, but data was inconclusive

18
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20
PRELIMINARY FINDINGS
  • Satisfaction
  • Evaluated using survey methodology
  • Utilized a Likert scale from no opinion to
    strongly agree
  • Monitor use
  • Symptom management
  • Perceived improvement in physical/emotional
    well-being and anxiety
  • Usefulness in care management
  • Professional staff rated the components, i.e.,
    blood pressure, pulse usefulness for care
    management

21
PRELIMINARY FINDINGS
  • Satisfaction
  • Overall physician/patient / caregiver and nurse
    were highly satisfied with telemonitoring
  • Physicians found trending most useful
  • Patients perceived improvement in anxiety,
    physical well-being, and support
  • Nurses perceived value in symptom management and
    anxiety reduction for their patients

22
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23
RECOMMENDATIONSGoing Forward . . .
  • Better evaluation of the impact of monitoring on
    medication management and costs
  • Utilization of a Hospice valid quality of life
    tool
  • A study design with a monitored group and a
    control group to evaluate the differences of
    home monitoring on end of life care

24
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