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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