Title: Hospice and Home Monitoring Care at the End of Life
1Hospice 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
2VNA HEALTHCARE PARTNERS OF OHIO
3WHY HOSPICE HOME MONITORING?
- VNA Home Health experience
- Clinical Outcomes
- Business Opportunity
4WHY 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
5WHY 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
6WHY 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
7THE PLAN FOR IMPLEMENTING HOSPICE HOME MONITORING
- Barriers
- Attitudes
- Territory
- Cost
8THE 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
9THE PLAN FOR IMPLEMENTING HOSPICE HOME MONITORING
ADDRESSING THE BARRIERS
- Executive Approval
- CEO
- VP Operations
- Other Executives
- Largest impact
- Quality Assurance
- Market Changes
10THE PLAN FOR IMPLEMENTING HOSPICE HOME MONITORING
ADDRESSING THE BARRIERS
- Staff Education Peer Review
- RN Palliative Care Coordinator
- Medical Director support buy-in
11THE PLAN FOR IMPLEMENTING HOSPICE HOME MONITORING
ADDRESSING THE BARRIERS
- Community Education and Outreach
- Team Meeting
12THE 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
14PILOT
15EVALUATION
- Impact on clinical care delivery
- Financial Analysis / ROI
- Satisfaction
- Patient / Caregiver
- Nurse
- Physician
16PRELIMINARY 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
17PRELIMINARY 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
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20PRELIMINARY 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
21PRELIMINARY 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
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23RECOMMENDATIONSGoing 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
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