How to ensure successful implementation of telemedical care? · 17 IC/CC nurses 2 Coordinators...

Isala Heart Centre | Zwolle, The Netherlands

How to ensure successful

implementation of telemedical care?

Astrid van der Velde, PhD

April 6, 2017

Virtual Heart Centre the use of mobile technologies

in cardiology

▪ Irreversible loss of function

▪ High chance of

▪ delirium

▪ hospital induced infectious disease

▪ falling

Clinical deterioration in older adults with delirium during early hospitalisation:

a prospective cohort Study. Hsieh SJ, et al. BMJ Open 2015;5:e007496.

doi:10.1136/bmjopen-2014-007496

Hospital admissions are harmful,

especially for the elderly

VIRTUAL HEART CENTRE

“ Hospital care in the living environment of the patient

”

Professionals

on distance

e- & m-Health Tech

Sensors in/on patient

Point of care Tech

Hospital care

without a

hospital

❑Chance@Home clinical cardiac care at home

❑mHealth guided cardiac rehabilitation for patients with

an indication for cardiac rehabilitation

❑Tele-monitoring for patients with chronic heart failure

and device (PM/ICD) patients

❑Mobile emergency cardiac care unit

❑ Interactive m-Learning

VIRTUAL HEART CENTRE SERVICES

❑Chance@Home clinical cardiac care at home

❑mHealth guided cardiac rehabilitation for patients with

an indication for cardiac rehabilitation

❑Tele-monitoring for patients with chronic heart failure

and device (PM/ICD) patients

❑Mobile emergency cardiac care unit

❑ Interactive m-Learning

VIRTUAL HEART CENTRE SERVICES

Clinical care at home

eHealth facilitated

Specialised nurses

24/7service

CHANCE@HOME

❑ Acute exacerbation of known and well

assesses chronic heart failure

❑ ADL self supporting / sufficient support

❑ Living < 30 kilometres from heart centre

❑ 17 IC/CC nurses

❑ 2 Coordinators

PATIENT MEDICAL

TEAM

Region

CHANCE@HOME

CHANCE@HOME

✓Home visit(s)

✓ Interview

✓ Physical examination

✓ Intravenous medication

✓Monitoring (sO2, BP, ECG)

✓ Lab testing

CHANCE@HOME

✓ Increasing number of direct home “admissions”

Year Heart failure Pulmonary embolism Pneumothorax ShortStay Home visit Total

2009 76 6 61 143

2010 66 45 301 412

2011 91 64 9 343 507

2012 72 57 8 337 474

2013 83 65 12 294 454

2014 77 67 22 387 553

2015 81 68 21 408 578

2016 74 74 20 24 458 650

2017* 31 27 8 11 235 312

Total 651 473 100 35 2824 4083

✓High patient satisfaction

✓Vulnerable patients benefit most

✓Low percentage infections

✓No delirium

✓More active patients

✓Less falling

✓Cheaper

CHANCE@HOME

❑Chance@Home clinical cardiac care at home

❑mHealth guided cardiac rehabilitation for patients with

an indication for cardiac rehabilitation

❑Tele-monitoring for patients with chronic heart failure

and device (PM/ICD) patients

❑Mobile emergency cardiac care unit

❑ Interactive m-Learning

VIRTUAL HEART CENTRE SERVICES

MOBILE CARDIAC REHABILITATION

(mCR)

More compliance of a healthier lifestyle by

an extended cardiac rehabilitation

programme.

mCR PURPOSE

Increasing participation of a CR

programme by including patients in mCR

who refused participation in a traditional CR

programme.

“

“

”

”

mCR EVIDENCE

Effect of comprehensive cardiac telerehabilitation on one-year cardiovascular rehospitalization rate, medical costs and quality of life: A cost-effectiveness analysis

❑ BETTER PATIENT CARE

❑ COST-EFFECTIVE

CURRENT RESEARCH

❑ Isala Telecare study

❑ EU-CaRE RCT study

❑Chance@Home clinical cardiac care at home

❑mHealth guided cardiac rehabilitation for patients with

an indication for cardiac rehabilitation

❑Tele-monitoring for patients with chronic heart failure

and device (PM/ICD) patients

❑Mobile emergency cardiac care unit

❑ Interactive m-Learning

VIRTUAL HEART CENTRE SERVICES

Telemonitoring

Purpose telemonitoring in heart failure

patients:

• Timely detection of deterioration

• Reduction hospital visits and admissions

Telemonitoring

Telemonitoring offers the patient:

• Comfort of measuring at home

• Insight in own health status

• No travel bother or costs

• Monitoring by specialised HF nurses

Telemonitoring

Lessons learned:

1. Health care process leading

2. Construct a suiting organisation

3. Then choose fitting and supporting

technology (technology is secondary)

MOBILE CARDIAC CARE

Virtual Cardiac Care