CASA Secondment: Good practices from the Veneto Region Francesca Vanzo, Arsenàl.IT Poznan, 04 th April 2014

The Veneto Region 4,9 M inhabitants km 2 of land surface 581 municipalities in 7 provinces

The Health and Social care System Veneto Health system Public accreditated institutions64 Local Health Authorities21 Hospital Trust2 Private accreditated institutions14 Medical & nursing staff Laboratory technicians Administrative staff6.704 Other professionals117

The Health and Social care System Social Services Directorate of Social S Facilities Head of Department of Health Department of Health and Social Services

The secondment in the Veneto Region - Topics The regional health and social care system Integration of telehealth and telecare services: the role of the regional eHealth centre and the Renewing Health EU project Local coordination centre: the role of the centre CURA in coordinating health and social services for elderly and frail patients living in Treviso Telemonitoring services for patients with implantable cardiac devices Care provision for frail elderly patients: the ARCA Project Protected discharge pathway: integration between hospital facilities and local care services in LHA of Verona Community hospital and health district care

The secondment in the Veneto Region – Good practice The regional health and social care system Integration of telehealth and telecare services : the role of the regional eHealth centre and the Renewing Health EU project Local coordination centre: the role of the centre CURA in coordinating health and social services for elderly and frail patients living in Treviso Telemonitoring services for patients with implantable cardiac devices Care provision for frail elderly patients: the ARCA Project Protected discharge pathway: integration between hospital facilities and local care services in LHA of Verona Community hospital and health district care

Case Study 1

The role of the regional eHealth centre Telecare: Emergency Response Service plus Telecontrol Domotic devices/Environmental monitoring (optional): fall sensors, water sensor, LPG sensor, smoke sensor, etc. Support to the Territorial Services: Access to GP’s, Home Nursing Services, Specialist second opinion services Access to secondary care: Front/Back Office & Call Center booking service Informative Services and Technical Help Desk Telehealth and Disease Management: Telemonitoring of clinical parameters Life Style Monitoring

Telecare services Administered by the Social Services of 581 municipalities since more than 25 years and effectively managed by the regional eHealth centre. It covers more than 24,000 citizens over 65 years old with frail conditions in the whole Region with the following services: Emergency response : 24/7 detection of any potential critical episode occurring at home, such as falls, deterioration of symptoms and any other kind of inconvenience that can affect the patient well-being everyday life conditions or needs and educate patients to use the devices Telecontrol service : scheduled telephone contacts to monitor the psychophysical state of the user and identify potential need for further intervention

Telehealth service Requested by the patient’s physician (GP or specialist) and effectively managed by the same regional eHealth centre. In the context of the Renewing Health EU project a group of telecare users with chronic diseases (COPD, Heart Failure and Diabetes) were enrolled and provided with also the telehealth service. The regional eHealth staff is in charge of: Keeping patients’ clinical parameters under control Reminding patients of taking measurements according to the scheduled plan Filtering false positive measurements Managing alarm situations according to their priority and intermediating with the healthcare professionals (or eventually emergency services)

Telecare and Telehealth platform Patient’s home Regional eHealth Centre SERVER DATA TRANSMISSION DATA ACCESS THROUGH HOME CARE PORTAL ALARM MANAGEMENT PATIENT 1 GATEWAY TELEMONITORING DEVICES REGIONAL CENTRE’S OPERATOR ALARM DEVICE 6 7 GENERAL PRACTITIONER HOSPITAL OR LOCAL HEALTH DISTRICT INTERVENTION SERVICE SOCIAL WORKER FAMILY

Talking about numbers… Telecare In the period : More than 45k true alarms managed More than 10 mil scheduled phone calls (210k call/month) TeleHealth In the period About 70k alarms received, 36% true alarms  eHealth centre is an important preliminary filter Among true values, 76% are less severe alarms (green), 14% medium alarms (yellow), 10% very severe alarms (red)

Case Study 2

Care coordination unique centre Unique telephone number for all the elderly and frail patients already in a home nursing program in the Treviso area. Interchangeable staff management with resources with professionals coming from the 4 health districts of LHA of Treviso (doctors, nurses, administrative personnel, health and social care operators) 24/7 availability Prioritization of requests and needs (triage management) Categorization of inbound requests and management according to standard procedures

Inbound requests/needs Deferrable (answer within 150 min) Provision of drugs and medication material General information (front-end opening hours, remind of appointment for blood test, etc.) Home visits (dates) Nurse services (blood infusions, enema administration, etc.) Notification of hospital admissions, discharges, death No deferrable (answer within 90 minutes) PEG (bleeding, occlusion or dislocation of the feeding tube) Tracheotomy (dislocation of the tube, bronchoaspiration) Infusion (dislocation of the needle)

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