THE APPLICATION OF TELECARE FOR PATIENTS WITH CARDIOVASCULAR DISEASE Feipei Lai National Taiwan University flai@ntu.edu.tw 3/22/2010

OUTLINE Why do we need telehealthcare service? Previous experiences Infrastructure for Continuous Care Service Case Study Conclusion

Why do we need telehealthcare service? Top 5 high cost diseases: Dialysis, Dentistry, Cold/Flu, High blood pressure, Diabetes 4 billion US dollar annually 1/3 of Taiwan National Health Insurance Expenditure Average hospital visit (2008) : 15 times/year (population: 23 M)

Between January 2004 and December 2004, chronic heart failure patients who were followed up by specialist nurse-led telephone visiting regularly were enrolled. Clinical and financial data half a year before enrollment were collected as control. A total of 247 patients (168 males, 79 females; mean age, 60 ± 17 years) were enrolled. J Formos Med Assoc 2007;106(4):313–319

J Formos Med Assoc 2007;106(4):313–319

J Formos Med Assoc 2007;106(4):313–319

before after change (%) Cost (US$) Inpatient cost 624,020 362,722 -41.8 Non-Heart Failure cost 541,800 184,136 -66.0 ED cost 6,528 6,101 -6.5 OPD 90,783 94,855 4.4 Duration Inpatient 2,127 1,042 -51.0 Non-Heart Failure 1,729 556 -67.8 ED 66 45 -31.8 ICU 327 160 -51.1 Visit Admission 109 73 -33.0 Non-HF Inpatient 82 26 -68.3 43 27 -37.2 35 12 -65.7 1,085 1,352 24.6

EFFECTIVENESS The previous study confirmed that home-based intervention with nursing specialists improved the clinical outcome and provided cost-savings for Taiwanese patients with systolic heart failure.

INFRASTRUCTURE FOR CONTINUOUS CARE SERVICE National Taiwan University Hospital (NTUH) established a telehealthcare center in 2009, to provide a continuous healthcare service, while the patients stay at home Normal Discharge Before Admission Virtual OPD Service Home Care Service After Early Discharge

INFRASTRUCTURE FOR CONTINUOUS CARE SERVICE

Telehealthcare equipment-Patient site Gateway plug & play store and transfer

Telehealthcare equipment-Patient site

Telehealthcare equipment-Patient site

Telehealthcare equipment-Patient site

Telehealthcare equipment-Patient site

Telehealthcare equipment-Patient site

Telehealthcare equipment Video Conference

Telehealthcare equipment-Hospital site

Telehealthcare equipment-Hospital site

Telehealthcare equipment SpO2-Hospital site

Telehealthcare equipment-Hospital site

CASE STUDY 87 year old female, with history of atrial fibrillation, arrhythmia 2009/10/06 discharged after bone fracture operation

CASE STUDY 2009/10/12 Symptoms of respiratory distress SPO2 75% Case manager immediately contacted cardiology surgery, emergency treatment

CASE STUDY pulmonary embolism → operation

INITIAL RESULT Year/Month 2009/10 2009/11 2009/12 2010/01 2010/02 Patient 65 81 51 62 57 Signout 2 5 6 Average Admission Stay 8.26 8 9.39 8.4 8.2 14 Day Emergency Department Visit 13 (21%) 10 (13%) 7 (14%) 6 (10%) 5 (9%) 14 Day Readmission Rate 8 (12%) 6 (7%) 5(10%)

Enrollment Follow-up Patient No. 65 81 51 62 57 Stay 8.26 8 9.39 8.4 2009/10 2009/11 2009/12 2010/1 2010/2 Follow-up Patient No. 65 81 51 62 57 Stay 8.26 8 9.39 8.4 8.2 control 96 98 107 93 - 11.17 10.53 10.04 10.6 56

CONCLUSION The Department of Health of Taiwan has been establishing a national health insurance that includes continuous care service. A new service infrastructure is needed to support post- hospital community service, and provide continuous and comprehensive care service Our project demonstrates an infrastructure to enabling integrated personal healthcare service. (to be effective on 2011)