richard mendelsohn- beyond 2010: smart living panel

Beyond 2010 – Digitally Enabled Citizen

Birmingham OwnHealth

Thursday 21st October

Dr Richard Mendelsohn – Clinical Director: Chronic Disease Systems

Drivers • Inequalities in Health Outcomes for chronic diseases across NHS

BEN population• Everyone with a LTC needs to have a personalised care plan by 2010• Everyone with LTC should have an information prescription by 2008• Increased integration of health and social care teams around the

needs of the individual• Single point of access for orchestration and co-ordination of care• Supporting independence, self-care and self management• Tele-Empowered patients can make choices and have their self-care

supported• Bends the trend – bridging the affordability gap• Systematically move care from unstructured and reactive to structured

and proactive

Objectives of the service

• To improve the quality and length of life for people with long term conditions by improving their ability and confidence to manage their condition.

• To reduce the unscheduled and unplanned utilisation of health services by people with long term conditions whilst improving the overall quality of care received.

Outcomes

• The ultimate aim of the programme is to empower members to make positive changes to the way in which they manage their health. This in turn improves clinical metrics and reduces utilisation of healthcare services including acute care. The outcomes that will be expected to be delivered by the service provider are as follows:

• A. A significant reduction in members’ cardiovascular risk factors (body mass index, total cholesterol, systolic and diastolic blood pressure and HbA1c) from their initial measurements, with those members at highest risk demonstrating the greatest changes

• B Members reporting an increased confidence in their ability to self-manage their condition

• C. A measurable trend in which members require fewer GP practice appointments, specialist appointments, hospital admissions and visits to Accident & Emergency departments.

Eight care management priorities

Learn about the condition and set treatment goals

22Make lifestyle changes and reduce risks

66

Know how and when to get help

11Act to keep the condition in good control

55

Get recommended tests and services

44Follow up with specialists and appointments

88

Take medicines correctly

33

Build on strengths and overcome obstacles

77

Monitoring Centre can support administration duties, provide basic triage when appropriate, quantify results, coordinate installation and removal and act as a valuable communication hub

Clinicians perform daily triage of patient caseload

Based in patient homes

Telehealth

Current Status• 9170 members: 2590 monitor level, 6400 support level, and 180 with Assistive Technology•12,000+ patients in pipeline (i.e. eligible for service)• 30-40 members disenroll each week• 39 GP practices automated data sharing with BOH• Current Staffing:

– 1 Band 8a Programme Manager– 1 Band 7 Service Delivery Manager– 7 Band 6 Clinical Team Leaders ( 6 WTE) – 42 Band 6 Care managers (39 WTE)– 18 Band 5 Associate Care managers (16 WTE)– 6 Band 3 Recruitment Specialists (5.8 WTE)– 8 Band 4 Health Coaches– 1 Band 3 Secretary

Avoidable Hospitalisations

Avoidable A&E visits

Total costs Condition-specific

costs

Diet Exercise Medication

concordance Self-monitoring

behaviours

HbA1c LDL cholesterol BP BMI Immunisations Eye exam Foot exam Appropriate

medications

Social support

Self-efficacy

Health behaviour

change

Recommendations

Care Plan Development

Contacts Tasks

Psycho-social factors

Reduction in Avoidable Utilisation

Clinical Improvements

Improvements

Total No.: 478

Hospitalisation- Self Declared

AT Admission data Sept 08 –June 09

35 patients

Emergency Planned Waiting list

B A B A B A

62 8 0 1 1 2

• Years 1 and 2 - detailed internal ongoing outcomes and evaluation programme

• Year 3 - independent assessment by the University of Birmingham to be published 2010 see website

• Year 3 – expecting internal ongoing outcomes and evaluation programme

• Department of Health/Ernst & Young – evaluation

But i) Regression to mean, and

ii) A complex intervention

iii) Population-based

Evaluating Birmingham OwnHealthEvaluating Birmingham OwnHealth

Birmingham University study

• 676 BOH patients compared with 31,077 controls from GP research database

• Outcome 8-11 months after baseline

• Adjusted for age, sex, baseline values, smoking status, length of follow up, deprivation score

An evaluation of Birmingham OwnHealth telephone care management intervention among patients with diabetes or heart disease. A retrospective comparison with the General Practice Research Database.Rachel Jordan, Robert Lancashire, Peymané AdabUnit of Public Health, Epidemiology and Biostatistics, University of Birmingham.

BOH patients with diabetes

Mean change compared to controls

HbA1c -0.2% [-0.4, -0.1]

Systolic BP -3.4mmHg [-5.5, -1.4]

Diastolic BP -1.8mmHg [-3.0, -0.6]

Total cholesterol -0.1mmol/l [-0.3, -0.1]

BMI -0.7kg/m2 [-1.1, -0.4]

Comparison of satisfaction with care management at year 1 and 2