Taking care home
Personal · Nov 15, 2017
Health monitoring at home empowers patients and cuts costs
Moving from acute to self-care can be tough. Home health monitoring (HHM) helps maintain the critical connection between patients and care teams during these transitions. In some B.C. pilots, heart failure patients with HHM in place used healthcare services 76% less than heart failure patients not using home monitoring.
When her patients’ pedometer readings are low, Claire knows something’s wrong.
“One of my COPD patients was down to only hundreds of steps a day,” said Claire, a Victoria home health monitoring nurse. “When I called him, he said he wasn’t getting outside for his daily rehab walk because his oxygen supply kept freezing up.” Claire quickly connected her patient with a technician, who then fixed the problem.
And this happened without a single patient appointment or nurse visit.
Claire and her patient were part of a home health monitoring (HHM) pilot program, one of several in British Columbia and Yukon, where pedometers are one of the devices that patients with chronic conditions such as COPD and heart failure are using to manage their recovery.
Easing the transition from acute to home
“All patients, but especially chronic disease patients, need a safe and high quality transition from hospital to home,” said Dr. Kendall Ho, Lead for University of British Columbia Digital Emergency Medicine and co-lead of Vancouver’s TEC4Home HHM pilot program, together with Vancouver Coastal Health and Providence Health Care.
The statistics illuminate the critical need for better transitions.
In Canada, 18% of COPD patients are admitted to hospital once a year, while 14% are admitted twice. A full 40% of discharged heart failure patients are re-admitted to hospital within three months.1
Recurring hospital admissions are discouraging for patients, but also costly to the system. To combat these issues, HHM programs like the ones running in Yukon and several B.C. Health Authorities (Island, Interior, Vancouver Coastal and the Provincial Health Services Authority) extend patient monitoring beyond hospital walls.
“Patients are healthier at home, where they’re at ease, with family, and in familiar surroundings,” said Gayle Anton, Director of Chronic Disease Management and Home Health at B.C. Interior Health. “With our HHM programs, we’re bridging the gap by providing specialty care in patients’ homes that allows for intervention as needed.”
In the HHM pilots, heart failure and COPD patients are set up at home with devices that measure their heart rate, weight, blood pressure, oxygen saturation and activity level. Every day or more often, they send these vitals to an HHM nurse and answer an online questionnaire on how they feel, physically and mentally.
“With minimal training and support, most patients find the devices easy to use and the protocol simple to follow,” said Lisa Saffarek, Senior Specialist, Virtual Care & Telehealth at Vancouver Island Health Authority.
HHM pilots return astounding results
Some B.C. health authorities, such as Interior Health, have been successfully using some form of HHM for over a decade. Recent results from chronic disease pilots in both Interior and Vancouver Island Health Authorities confirm why.
Pilot participants loved the programs: 100% of COPD patients said they would recommend it to others. And 86% of healthcare professionals reported satisfaction with their ability to deliver care.
But most remarkably, the need for healthcare service was dramatically reduced. For example, patients in Interior and Island Health’s heart failure pilots used care 76% less than the average heart failure patient.
While this shows overwhelming promise for cost savings, the bottom line is that HHM keeps patients healthier—and happier. What contributes to this striking improvement in health? Put simply, three factors: HHM encourages engagement, strengthens care team connections and permits earlier interventions.
Technology is at the heart of HHM. But it’s how patients engage with the technology and their provider team that makes HHM successful.
“It’s really a patient-practitioner partnership to track and speed recovery,” said UBC’s Dr. Kendall Ho, who is co-leading a new HHM pilot program in Vancouver.
For the teams at Interior and Island Health, it was critically important that the reporting interface that patients accessed daily set an engaging and positive tone. With the help of patient partners, they worked and reworked the health questionnaire and tips to be encouraging and helpful. This partnership between patients and providers really paid off.
“The protocol questions encourage a client to follow their action plan and reflect on how they’re feeling every day,” said Island Health’s Lisa Saffarek. “This helps engage them to be proactive with their condition.”
Subsequent pilots followed the protocols set by Island and Interior Health.
The questionnaire’s daily hints are also leading to better self-care. “Many COPD patients and their home helpers didn’t know that flare-ups cause longer term lung damage,” said Anne Aram, Project Manager for Yukon’s Territorial Health Investment Fund, Chronic Disease Management. “Learning this motivates them to do everything they can to avoid a flare-up.”
Pedometers have also proven key to engaging patients in their recovery by boosting daily activity levels. Lori, a B.C. nurse, saw this engagement in action with her elderly neighbour.
“When he came home from the hospital, he honestly looked like he had one foot in the grave,” she says.
But day after day, she saw him out walking. Slowly at first, then with more vigour. Finally, she asked him how he was improving so quickly. He told her he was a part of an HHM program, and his new pedometer had inspired him to walk a bit farther every day.
As a result of these learnings from patients, every B.C. HHM program for chronic disease will now include a pedometer.
Stronger connections with care teams
Both patients and care teams are noticing closer ties created by the daily HHM conduit.
“It’s the relationships you build, facilitated by technology, that become important in patient care,” said Yukon’s Anne Aram.
Being connected into their circle of care every day gives patients peace of mind that they’re getting better, since their care nurse is trained to spot any early sign of relapse.
“HHM gave me confidence in my recovery,“ said Maurice King, an HHM client. “I can call my nurse anytime I’m concerned about something, and she calls me at least once a week.”
Clinicians feel they can track a patient’s recovery more successfully than when patients simply went home and checked in from time to time. They feel they’re making a bigger difference in the lives of their patients.
The program also helps family caregivers. “My family is feeling quite a bit more at ease since I’ve been on the program,” said HHM client Elizabeth Brand.
Many stories coming out of these pilots are about faster responses to worsening conditions. When caught early, issues can often be solved by adjusting meds, revisiting the recovery plan, or other simple interventions.
For example, pedometers are not only inspiring patients to walk. They’re also proving to be critical health indicators for nurses.
Said Island Health’s Lisa Saffarek: “Dropping from 5,000 to 1,000 steps a day may indicate fatigue, which can be an early predictor of a flare-up, the primary reason for a COPD patient to visit emergency. When we know a flare-up is coming, we can ward it off and even treat it at home.”
“HHM has the potential to decrease the burden on acute care,” added Gayle Anton from Interior Health in B.C. “But more importantly, it lets us catch problems early and provide needed interventions, or support patients as they self-manage.”
Home health monitoring to reach further
So convincing are the HHM pilot results that both B.C. and Yukon are expanding the pilots to more regions.
Bringing care to rural and remote areas
In B.C., the Island and Interior Health Authorities each serve the health needs of some three quarters of a million people in smaller cities and rural areas scattered over vast distances. Yukon is challenged to bring care to 38,000 people spread over half a million square kilometers—often in hard-to-reach places. In these areas, HHM really benefits patients discharged from regional hospitals who must return to remote communities far from health services. Said Yukon’s Anne Aram. “Taking healthcare to people in their own homes, especially in remote communities where access can be difficult, may increase self-management, result in better outcomes and reduce the stress of having to travel for care.”
“Rigorous study will help us know the very best way to offer HHM so that it benefits patients as much as possible,” said Dr. Kendall Ho of the Vancouver TEC4Home partnership.
“What are the critical services? What are nice-to-haves? What doesn’t work? Then we’ll know when we expand these programs across the province—maybe even across the country—that we’re helping Canadians be as healthy as possible.”
“HHM is only in its infancy,” said Heather Harps, HHM Initiative Director at TELUS Health. “The benefits of today’s pilots speak for themselves. And their lessons are creating the rich store of insight that will benefit all future programs.”
We look forward to seeing more HHM programs that support providers, ensure happy, healthy patients, and deliver more savings on an even larger scale.
This article was initially published in Canadian Healthcare Technology, vol. 22, no. 7 October 2017 edition.