iHT² CMIO Symposium Beverly Hills – Opening Keynote: Kamal Jethwani, MD, MPH, Corporate Manager – Research and Innovation, Partners Healthcare Center for Connected Health
Kamal Jethwani, MD, MPH
Corporate Manager - Research and Innovation
Partners Healthcare Center for Connected Health
iHT² CMIO Symposium Beverly Hills – Opening Keynote: Kamal Jethwani, MD, MPH, Corporate Manager – Research and Innovation, Partners Healthcare Center for Connected Health
Ähnlich wie iHT² CMIO Symposium Beverly Hills – Opening Keynote: Kamal Jethwani, MD, MPH, Corporate Manager – Research and Innovation, Partners Healthcare Center for Connected Health
Ähnlich wie iHT² CMIO Symposium Beverly Hills – Opening Keynote: Kamal Jethwani, MD, MPH, Corporate Manager – Research and Innovation, Partners Healthcare Center for Connected Health (20)
iHT² CMIO Symposium Beverly Hills – Opening Keynote: Kamal Jethwani, MD, MPH, Corporate Manager – Research and Innovation, Partners Healthcare Center for Connected Health
9. Connected Cardiac Care Program (CCCP)
A Patient’s Perspective
“This program gave me a great sense
of support and comfort.
It taught me discipline to watch my
weight and my blood pressure, and
to make changes before I end up in
the hospital.”
George Ruboy
Connected Cardiac Care patient
10. Proportion of CCCP Enrollees with >1 Hospitalizations
% of CCCP Enrolles
100
58.10
39.80
13.30
1 yr prior to CCCP
enrollment (point
estimate & 95% C.I.)
1 yr following CCCP
disenrollment (point
estimate & 95% C.I.)
50% Drop in
Readmissions
Data Includes 332 CCCP enrollments among 301 unique patients discharged from the CCCP program prior
to July 1, 2009. Results are similar within more recent cohorts of enrollees discharged from the program
prior October 1, 2009 and prior to January 1, 2010.
11. Diabetes & Blood Pressure Connect
Average drop of HbA1c: 1.5
69% achieved a drop in BP
12. Greater Engagement associated w/ Greater Pre-post HbA1c Change
Average drop HbA1c by # of uploads
1.8
1.53
Drop in HbA1c
1.6
1.34
1.4
1.2
1
0.8
0.6
0.43
0.4
0.2
0
no uploads
1 - 15 uploads
> 15 uploads
Practice engagement correlates strongly w/ better patient outcomes
Patients w/ >15 uploads had average 1.5 pre-post HbA1c change
P< 0.03 between no uploads vs. uploads groups
13. Engaged Providers = Engaged Patients
n = 91 patients
PRACTICE 1
PRACTICE 2
Avg. change A1c - Total
- 0.8
- 1.5
Avg. change A1c – Active patients only
- 0.7
- 1.8
Avg. change A1c – Non-active patients only
+ 0.9
+ 0.4
6
28
Provider logins / month
14. The Power of Simple Messaging
Medication reminders, encourage pre-natal care, etc.
Instant messaging ‘in path’ – reach patients where they are
Lower barrier to adoption, higher engagement
70%
Weekly Adherence Rates (mean +/- SEM)
Reminder group
60%
No Reminder Group
% Adherence
50%
40%
30%
20%
10%
0%
Week 1
Week 2
Week 3
Study Period
Week 4
Week 5
Week 6
16. Rise of the Consumer-Patient
Patients are Online:
78% of U.S. adults use the Internet
80% of Internet users look online for health info
20% of adults have tracked their weight, diet, exercise
routine or some other health indicators / symptoms online
Self-service Health:
73% want online access to their physician
47% would consider switching doctors to
one whose office offered online access
Sources:
Pew Internet & American Life Project, 2011
Intuit Health Survey by Decipher Research, 2011
19. Model for Patient Collaboration
Current (Paternalistic)
Future (Collaborative)
Patient
Physician
Patient
Physician
Passivity-Activity
Passive
ACTIVE
ACTIVE
ACTIVE
Decision making
----
Primary
Shared
Shared
Non-personal health info
access (e.g., research)
None/little
Full
Full
Full
Personal health info
access (e.g., lab results)
None/little
Full
Full
Full
Asymmetric
Knowledge/Info symmetry
Symmetric
Liability/Accountability
None/little
Full
Shared
Shared
Empowerment
None/little
Full
Shared
Shared
Use of tools
No
Yes
Yes
Yes
Awareness of costs
No
Sometimes
Yes
Yes
Skills needed
No
Yes
Yes
Yes
Roles
-----
Data collector,
decision maker,
treatment
provider,
gatekeeper
Data collector,
information
seeker, shared
decision maker
Guide for
non-routine
problems
19
1
20. Accountable Care Organizations
Improve
efficiency &
patient
satisfaction
Improve
patient care,
support
self-care
Shared vision
&
commitment
Improve data
collection,
integration,
& exchange
Quality of
care & Costs
Lower
Overhead
Maintain
infrastructure
& remain
flexible
Adapted from:
http://www.med3000.com/Por
tals/46580/images/healthcare
_it_chartfinal1(2).png
21. Role of mHealth in Patient-Centered Medical Home
Enhance access & continuity?
Plan &
manage care?
PCMH
Identify & manage
patient population?
PATIENT
Provide self-care
support & community
resources?
Track &
coordinate care?
Measure & improve
performance?
22. AIM: Better Health for Populations
ACO #22-27 At-Risk Population: Diabetes
All or Nothing Scoring:
Hemoglobin A1c Control
Low Density Lipoprotein
Blood Pressure
Tobacco Non Use
Aspirin Use
Patients whose most recent
hemoglobin A1c level >9.0%
Patients aged 18-75 with
diagnosis of diabetes
“It keeps me aware of what
I’m doing and gives me a
better frame of mind about
my condition.”
Leo Jabotte
Diabetes Connect patient
23. Take-Aways
Remote monitoring & self-management strategies can
drastically impact quality of care and cost of delivery
Patient engagement in these programs can be
improved by:
improving provider engagement
appropriate use of technology
personalization tactics
Many ACO metrics can be achieved by engaging
patients in their care & leveraging data collected from
outside the hospital
24. Regina Holliday, “Silos”
Thank you!
Kamal Jethwani, MD MPH
Corporate Manager, Research and Innovation
Partners HealthCare Center for Connected Health
kjethwani@partners.org