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GE, Philips, Intel, Mayo Clinic: Why do this telehealth study again and again?
Mon, 03/01/2010 - 09:41 - Laurie Orlov
Everybody's doing it - reproving benefits of telehealth. When you put these together, you have to ask why. What is the reason that large organizations don't cite previous studies rather than spend money to prove the same point? We're not talking about drug trials here, we are talking about telehealth monitoring, a technology that has been around for a decade at least, that has been studied and deployed, but not uniformly reimbursed (which is the real problem here). So it's 2010, and GE Healthcare, Intel and Mayo Clinic are launching a year-long study of a 'new' model of healthcare delivery, intent on "determining if home monitoring of patients with chronic disease will reduce hospitalization and emergency room visits." In this study, 200 high-risk Mayo Clinic patients will be monitored for vital sign changes (presumably using Intel Health Guide and some video conferencing) and will be evaluated in comparison to a control group that will be treated in the 'usual' manner. Sounds good.
Philips Healthcare releases their study results. Maybe after reading the GE press release, Philips decided to announce the preliminary results of a study funded by Philips and CARME (health service in Spain) -- this time using the Philips MOTIVA telehealth offering. No surprise, this 'innovative' use of telemedicine produced a 67.8% reduction in hospitalizations due to heart failure and a substantial improvement in perception of their quality of life (improved from a perceived quality of life), regardless of where their perceptions started. Sounds good.
Veterans Health Administration proved this in a 2008 study. Fortunately or unfortunately, depending on your perspective, the VHA study proved the same point with a similar population set suffering from chronic disease (and likely Viterion's telehealth technology, since the report is featured on Viterion's website.) In this study of 17,025 patients over 4 years, the benefits revealed were a "25% reduction in the numbers of bed days of care, 19% reduction in the numbers of hospital admissions after enrollment in the program and a mean satisfaction score of 86%." The conclusion: enterprise-wide home telehealth implementation is an appropriate and cost-effective way of managing chronic care patients in both urban and rural settings." Sounds good.
So what is behind Philips and GE's re-studying the same problem? So I admit that I am in the dark on this. Why not go with the first study and implement? Is it that they didn't believe the VHA methodology? That it seems to have used a product other than their own? That the continuous re-justification of care outside an institutional or medical setting is required because executives in hospitals still refuse to believe? Or is it possible that insurance and government programs here and abroad refuse to participate in telehealth, perhaps because doctors refuse, and perhaps that is because reimbursement rates are still not equivalent to face-to-face?
Just asking.
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Comments
Why study it again and again?
Why indeed? Product jealousy is part of it but I think that from the care organisation's point of view it is often easier to find funding for a one-off study than it is to implement a system fully. See the woeful tale of The University Hospitals of Leicester NHS Trust which literally shelved a telehealth system once the trial was over, although it was saving them money!
One possible answer:
Don't expect Turkeys to vote for Christmas!
If your business is "making money from running a hospital" (ie. filling beds) anything that will lead to a:
> 25% reduction in the numbers of bed days of care
> 19% reduction in the numbers of hospital admissions
Is going to be last on your list of things to do.
On the positive side this inactivity does leave a lot of opportunity for innovation with those of us who work outside the system!
Grants enable Bosch and California VA to move forward
Even with the VA, however, the way they are moving forward with telehealth is with grants?
VA and Bosch continue telehealth deployment in California.
And apparently the VA is ahead of the Federal government in even having a telehealth strategy.
CMS Funding with Bosch
CMS (Centers for Medicare and Medicaid Services) is also funding the Montefiore/CMO--The Care Management Company 6600-person program using Bosch's Health Buddy. (Care Management for High-Cost Beneficiaries).
http://www.healthbuddy.com/content/language1/html/6377_ENU_XHTML.aspx
The new mantra is 'preventing readmissions' (within 30 days of discharge) which CMS wants to do, so it makes sense for them to fund this study which also is about post-acute transition. The fact that it is large-scale and urban is positive to me.
Couple of answers
As mentioned before, the reimbursement model for hospitals focuses on bed days not days preventing bed days. There are other disincentives. Will we pay for doctors who see their patients by phone or over the internet? At some facilities like Kaiser, patients can email their doctor and if you have a panel of 2000 patients, thats a lot of time going through them and responding. Will the doctors be reimbursed for that time?
There are some additional legitimate reasons for telehealth studies. One is to understand whether these technologies are adaptable to all people in all situations. Another issue is the reliability issues. We see this in medically underserved areas where connectivity and power can be unreliable.
Another issue that remains especially with devices that need to have data input by the patient is the accuracy and compliance.
Lack of compliance with prescribed drug regimens is probably one of the largest problem areas and contributor to cost and bed days.
Why study it AGAIN
It's called control of the content. It's the exact same thing that the pharmas have been doing for years. Since you did the study and you know what is in it, a point missed in some other study will not come back to 'bite' you.
I agree though that how many times can you say 1+1 =2? It's probably also related to not wanting to agree your competitor's data might make sense and you missed jumping on the band wagon..oh well. . .
NIH- anyone?
Not Invented Here...
I seems like everyone is trying to develop a better mousetrap and they must be doing it in a vacuum!! Doesn't anyone RESEARCH what's already out there?
Sadly, if all the money that's been spent on this repetitive research could be channeled to the patients who actually need help, compliance would not be as big an issue as it is today. But that just makes sense - not dollars.
Most compliance gadgets are complicated and expensive, so the developers have to do a "study" to prove that their approach is the "silver bullet" and it's worth the cost - but is it?
When a simple automated call reminder works fine on any phone, who needs another expensive and complicated gadget?
Index of prior studies - another great service for this site?
I am all in favour of using, and if necessary building on other people's work. It is an absolute must-have when building business cases to get projects to go-ahead stage. Some of this really good material is hard to find when you want it. Any chance Ms. Orlov could add to the fantastic resource on this site by keeping a repository of all known studies (perhaps in date and area of interest order) - even inviting participants to add examples from their own knowledge and reach? That would be a huge benefit to the industry (and perhaps even prevent some of the duplication!).
Reader Telehealth Study Forum has been created
This was a great suggestion -- I will be posting the study links that are in this thread. Please feel free to add your own.
/forums/reader-telehealth-study-forum
Copies of the ACTUAL studies?
I dont want to seem ungrateful, but these are the press releases.
Any chance you could develop an archive OF THE ACTUAL STUDIES. Finding real published studies is difficult. It means we keep re-inventing the wheel instead of building on prior work, and/or using the outcomes of prior work to justify new advances.
Happy to post the actual studies -- but they all just started
FOr those who are closely associated with or aware of the studies' progress, please post. I will watch for alerts that indicate they have been completed. This is the actual report from the completed 2008 VA telehealth study:
http://www.viterion.com/web_docs/VA%20CCS%20Outcomes%20Dec_2008_Darkins.pdf
Why do it again?
It's another form of defensive medicine. Particularly when a device is FDA-regulated, companies are restricted by FDA from relating "category benefits" or making marketing ("labeling") claims by citing anything other than studies using their technology. Don't blame the companies, blame the feds.
Another VA Study, 2001
John Boden, ElderIssues, wanted to share the summary of a 2001 VA study which is below.
North Florida/South Georgia Veterans Health System
Geriatrics & Extended Care Service
Rural Home Care Project FY 2000 to FY 2002
VISN 8 implemented the Home & Community Care Service Line in April of 2000 through the funding of eight clinical demonstration pilots, with the objectives of increasing access to services, improving chronic disease management, improving patient satisfaction, and reducing resource utilization thus decreasing healthcare costs. In November of 2001 the Service Line transitioned to the Community Care Coordination Service and the Rural Home Care Project was integrated into the medical center under Geriatrics & Extended Care Service.
The Rural Home Care Project targeted patients with chronic diseases such as HTN, COPD, CHF, CAD, and Diabetes. Staff was selected and included two care coordinators, a nurse practitioner and social worker. In addition a program support assistant was also recruited for the project. In 2001 due to its early success the project was granted an additional care coordinator FTE for the Gainesville Division. Current staff members are Juanita Bradley, Program Assistant, Rita Kobb, ARNP Care Coordinator and Robert Lodge, SW Care Coordinator.
During the project’s two-year pilot over 425 veterans have been served. Currently there are 315 veterans being actively followed by the project team. There has been a 27% drop out rate related to death, permanent move out of service area or nursing home placement. Of this 27%, less than 5% did so due to dissatisfaction with the equipment or project. Project staff have developed a patient classification system that is being piloted VISN-wide.
During the demonstration phase of the pilot, the University of Baltimore, Maryland, evaluated statistics to demonstrate clinical and financial outcomes. Health care utilization outcomes were compared for each patient during the periods from 12 months pre-enrollment through the post enrollment period. Each patient was compared against themselves as well as a usual care group that were not enrolled in the project.
Rural Home Care outcomes data is as follows: (-for decrease; + for increase)
*data derived from comparison with usual care group
RHCP Usual care
Hospital Admissions -60% +27%
BDOC -68% +32%
NHCU Admissions -81% +11%
NH BDOC -94% +18%
Clinic Visits -4% +22%
ER Visits -66% +19%
Pharmacy -59% +37%
A performance improvement plan was also implemented which included measuring
satisfaction for patients, providers and employees at regular intervals, hypertensive
medication and immunization compliance, and functional status using the SF 36 V.
Rural Home Care data is as follows:
Patient Satisfaction 96% (target 90%)
Provider Satisfaction 97% (target 90%)
Employee Satisfaction 93% (all staff) (target 90%)
HTN Medication Compliance 93% (target 78%)
Flu vaccine 83% (target 78%)
Pneumovax 84% (target 78%)
The SF 36V Functional Status Assessment was completed on each patient at baseline and 6 month intervals during the demonstration. The following parameters are identified. The project goal was to maintain or improve health perception and function.
1. Physical functioning Improved
2. Role-physical Improved
3. Bodily pain No change
4. Vitality No change
5. Social functioning Improved
6. Role emotional No change
7. Mental health Improved
8. Physical composite Improved
Project patients showed improved perceptions of health after enrollment. Those indicators that showed no change were also seen as positive because a decline in function or perception of health in this population with its severity of illness would be expected.
John Boden, CE
ElderIssues LLC
801 N. Swinton Ave
Delray Beach, FL 33444
(561) 265-0016
jboden@elderissues.com
www.elderissues.com