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| Community Budget Issue Requests - Tracking Id #948 |
| Home and Community Based TeleHealth Monitoring |
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| Requester: |
Mike Verdeja |
Organization: |
United HomeCare Services, Inc |
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| Project Title: |
Home and Community Based TeleHealth Monitoring |
Date Submitted |
1/12/2006 10:15:40 AM |
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| Sponsors: |
Villalobos |
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| Statewide Interest: |
| There are more than 60,000 elderly individuals being served in various Home and Community Based programs throughout the State of Florida. The main goal of these programs is to allow elderly individuals that are dependant on State funded support to age at home in dignity and prevent premature institutionalization which would also prove very costly to the State. Unfortunately, under our current care model clients receive in-home social support services but no support in the area of clinical care or training on self-management of their chronic medical diseases, such as, Diabetes, Cardiac Conditions, Chronic Obstructive Pulmonary Disease (COPD) and High Blood Pressure. These potentially manageable chronic medical conditions become acute episodes often requiring ER visits and hospitalizations.
Typically, clients alternate from chronic to acute with no in-between managed state. In many cases these acute episodes can be avoided with early detection and prompt treatment. United Homecare Services has 2,827 clients currently in these programs. Of those 33% or 942 clients have a risk score of 40 or above. The risk score is a measurement that captures the client's frailty and similarities to individuals who are in nursing homes, therefore, it is an excellent measure of clients who are at risk of no longer being able to remain at home. Extrapolated based on statewide numbers we are looking at more than 6,500 (10%) of elder Floridians in Miami-Dade County, currently receiving services under Home and Community Based Services programs, who are known to be in the same condition. In Miami-Dade County alone, there are 35,695 elders age 65+ who have two or more disabilities including self-care limitation, and more than 41,000 elders who are deemed medically needy.
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| Recipient: |
United HomeCare Services, Inc. |
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Contact: |
Jose R. Fox |
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5255 N.W. 87th Avenue, Suite 400 |
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Contact Phone: |
(305) 716-0765 |
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Miami 33178 |
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Contact email: |
Jfox@unitedhomecare.com |
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| Counties: |
Dade |
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| Gov't Entity: |
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Private Organization (Profit/Not for Profit): |
Yes |
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| Project Description: |
| The Project we are proposing involves installing Telehealth monitors in an elders home based on certain qualifying criteria (including chronic disease states) which will allow for daily remote monitoring, of clinically relevant data, at a ��Central Station�� located in our main office, by a Registered Nurse. The immediate and early detection of precursors to acute episodes will prevent unnecessary acute episodes and will allow us to provide physicians with reliable data needed to alter when necessary the patient��s therapeutic regimens. This approach would also provide clients with daily virtual nurse visits which would prompt in-home visits when required. The information obtained from the devices will assist us in identifying areas of training required for clients & caregivers..
The approach we are proposing in implementing this program will allow us to validate and obtain our desired outcomes which are:
1. Identify precursors to acute exacerbations through daily monitoring of the clients vital signs and other clinical relevant data and provide intervention if necessary.
2. Stabilize chronic medical conditions of our high risk frail elderly by ensuring compliance to prescribed medications and daily evaluation of vital signs and trends.
3. Reduce caregivers stress and anxiety by providing peace of mind since a health professional is overseeing their loved one��s medical conditions.
There are documented reports of the benefits of monitoring clients that have chronic medical conditions. In a study conducted by Strategic Healthcare Programs, an independent national healthcare data services company, who looked at 60,000 + clients with chronic medical conditions on HomMed monitors versus clients with chronic medical conditions receiving traditional home care services without the benefit of monitoring. These clients were studied during a cumulative period of three years, from January 1, 2002 through March 31,2004. The results of the study illustrated the direct benefit of remotely monitoring patients and demonstrated measurable, significant declines in client hospitalizations and ER admissions. Below are some of the results obtained from the study:
"� 0.6% of individuals with Diabetes on HomMed monitors required hospitalization as compared to 2.4% who required hospitalization and were not being monitored. A 25% DECREASE
"� 0.3% of individuals with Diabetes on HomMed monitors required emergency room care versus 1.8% of the individuals not being monitored. A 16% DECREASE
"� 8.3% of individuals with COPD on HomMed monitors required hospitalization as compared to 16.8% of individuals not being monitored. A 49% DECREASE
"� 4.5% of individuals with COPD on HomMed monitors required emergency room care versus 13.1% of the individuals not being monitored. A 34% DECREASE
Additionally, based on numerous articles found in the American Diabetes Association Website, research has shown that there is a strong link between diabetes, heart disease and stroke. In fact, 2 out of 3 people with diabetes die from heart disease and stroke. Research has shown that by managing blood glucose (sugar), blood pressure and cholesterol, people with diabetes can reduce their risk of having a stroke. Changes in blood sugar levels, in a diabetes patient, can mean the difference between well being and serious danger, so controlling these levels is a crucial part of daily life. Also, a number of recent reports indicate that people with diabetes are not meeting recommended goals for blood glucose (sugar), blood pressure and cholesterol levels. The National Council on Patient Information and Education estimates that half of all medications are taken incorrectly each year. This includes forgetting to take medications, stopping medications too soon, incorrect dosing and incorrect scheduling. Therefore non-compliance to medication schedules result in 10% of all hospitalization and 25 % of all nursing home admissions. With the implementation of this program we are looking to achieve similar results within our population. The data gathered during the course of this program will have State-wide value since the target population is not limited to Miami-Dade.
During the monitoring period the client��s health conditions, such as vital signs, adherence to medication, weight and other relevant data, would be monitored daily from a remote location, at the ��Central Station��, by a Registered Nurse (RN). These monitors will be individually programmed based on the clients specific medical needs and/or conditions. The Case Manager will obtain the clients information and the RN will customize high and low measurement parameters for each of the clients�� biometric information, as well as, will select the peripheral devices such as pulse oximeter, weight scale, glucose meter, peak flow meter, etc, required to monitor their condition. The Case Managers will install the devices and will demonstrate/train the client and/or caregiver on how to use this technology and troubleshoot common problems. Once installed, daily remote monitoring begins at pre-set scheduled times which have been pre-determined based on patient preference as well as medication directions and schedules. Audio prompts instruct patients, in their preferred language, through each step of the monitoring process. The Central Station��s Clinical Software will display, results from telehealth monitors including actual readings where applicable as well as responses to voice prompt questions from the client at a glance using color coding, therefore, the RN can quickly identify issues that require follow-up and take necessary actions. This approach provides these clients with daily virtual nurse visits as well as in home visits as required. Additionally, the Central Database capturers and stores the bulk of data to be used to validate and measure the outcomes of our stated goals and objectives. Prior to installing the device the Licensed Clinical Social Worker (LCSW) and/or Case Managers will conduct a ��pre�� Zarit Burden Scale test on the caregiver, when applicable, in order to identify the baseline of the caregiver��s level of stress and anxiety prior to the installation of the Telemedicine Device, a post test will be conducted 60 days after the installation. Also a pre and post test will be provided to the client and caregiver in order to capture their level of knowledge of the chronic disease and how to deal with it prior to the monitoring device installation and after the Case Managers perform training. With the installation of the Telehealth monitors, daily monitoring of patients vital signs, appropriate intervention as necessary, as well as ensuring patient��s compliance to their prescribed medications we will be able to achieve our desired goal and outcomes.
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| Is this a project related to a federal or state declared disaster? |
No |
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| Measurable Outcome Anticipated: |
| This program merges home and community based services and clinical components funded through Medicaid. The goals of the program are to identify precursors to acute exacerbations and intervene as needed; stabilize chronic medical conditions of high risk frail elderly with Diabetes, COPD, Cardiac Conditions, and/or High Blood pressure; and reduce caregiver stress and anxiety. The project will be evaluated using both quantitative and qualitative results and identified specific outcome measures with respective baselines and targets for all objectives.
The anticipated outcomes UHCS would achieve by installing telemedicine devices in clients homes include:
1. Eliminate acute exacerbations in COPD clients being monitored triggered by rapid weight gain (5 lbs + 24 hours);
2. Eliminate hypo/her glycemic acute exacerbations among Diabetics being monitored. Baseline: Blood glucose range of 90-120.;
3. Maintain normal levels of blood pressure among clients with high blood pressure being monitored. Baseline: 120-130 /60-70 mm-Hg.;
4. Maintain normal O2 saturations levels on COPD and Cardiac Occurrence clients. Baseline: O2 saturation level with range of 90-100;
5. Increase client contact with case management agency to average of 20 contacts/month target population while monitored. Baseline: 1.2 contacts per month (from existing database).
6. Increase client knowledge of best practices for disease management by20%. Baseline: TBD (from Pre-Test). In the process, a curriculum will be implemented for clients that will be receiving the telemedicine boxes on a rotational basis.
7. Improve subjective health status score by -.21 (lower score is better) Baseline: 3.21 (from existing 701B assessment). Training on self-management of chronic diseases will be provided.
8. Reduce ER visits and hospitalizations. Baseline: TBD (based on individual clients previous history). A measurable reduction in number of ER visits and hospitalizations in one year period from initiation of monitoring.
9. Decrease caregiver burden in 30% of the caregivers. Baseline: TBD (from Pre-test). A reduction of caregiver burden based on results of Zarit Burden Scale Pre and Post tests. 1) measure burden levels on at least 50% of the 321 caregivers currently caring for clients with one or more chronic conditions 2) Provide training on use and benefit of telemedicine device on 100% of caregivers accepting use of device.
10. Increase caregiver knowledge of chronic disease of loved one. Baseline TBD (from Pre-test). Change in knowledge Pre and Post Tests. Implement training of at least 50% of the 321 caregivers currently supporting clients with one or more chronic conditions.
This program provides a means for high-risk clients to remain at home and in the community independently for as long as possible, but it would also help to reduce caregiver stress and anxiety. Incidentally, one of the factors for premature nursing home placement for clients with caregivers is high caregiver burden. Reduction in caregiver burden is an expected outcome of the telemedicine program.
The telemedicine program would also achieve cost savings to taxpayers and the State of Florida, for the costs of Nursing Home institutionalization are greater--every month that a client is placed in a nursing home prematurely, Medicaid would incur an estimated expense of $5,190. In contrast, the cost of 90 days of monitoring is $833, the equivalent of just 4.8 days in a nursing home. In fact, continuous telemonitoring for an ENTIRE YEAR is approximately $3,333, or 36% less than just ONE MONTH in a nursing home. Reduced ER visits and/or hospitalizations represent additional cost savings. There would also be a noticeable savings under the Medicare program. Studies performed by various telemedicine companies have demonstrated that once fully implemented, the average number of in-home visits will decrease by 37%. Among the reasons for this are that the device provide daily feedback and home visits can be scheduled around specific clinical indicators rather than randomly.
Being able to have daily "contact" with the clients and diagnose precursors to acute exacerbations to appropriately manage their care cost-effectively, reducing caregiver anxiety, and empowering clients to mange their health and remain at home with dignity and independence are just some of the reasons why this program is so important.
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| Amount requested from the State for this project this year: |
$347,000 |
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| Total cost of the project: |
$386,000 |
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| Request has been made to fund: |
Operations |
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| What type of match exists for this project? |
Private |
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Cash Amount |
$21,000 |
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In-kind Amount |
$18,000 |
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| Was this project previously funded by the state? |
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No |
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| Is future-year funding likely to be requested? |
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Yes |
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Amount: |
$347,000 |
To Fund: |
Operations |
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| Was this project included in an Agency's Budget Request? |
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No |
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| Was this project included in the Governor's Recommended Budget? |
No |
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| Is there a documented need for this project? |
Yes |
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Documentation: |
Extensive research conducted by Strategic Healthcare Programs |
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| Was this project request heard before a publicly noticed meeting of a body of elected officials (municipal, county, or state)? |
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No |
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| Is this a water project as described in Section 403.885, Laws of Florida? |
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No |
