1. CARE COORDINATION HOME TELEHEALTH (CCHT) VHSO Nurses Proud to Serve, Proud to Care Presentation by: Patricia Bennett, RN Veterans Health Care System of the Ozarks Fayetteville, AR

2. DEFINED AS: Ongoing monitoring using telehealth technology for prevention and treatment that enhances health of patients and prevents unnecessary utilization of resources Uses best practices derived from scientific evidence to bring together health care resources from across the continuum of care

3. VISION Patients will experience: Improved clinical outcomes Improved quality of life Utilize CCHT programs to promote: Right care Right place Right time

4. MISSION To improve and expand access to Veteran-centric, quality distance health by leveraging internal and external resources to improve and develop methods to meet the needs of our veterans. Coordinate the delivery of compassionate, patient-centered care that anticipates patient needs and is seamless across environments and conditions.

5. Veteran's Health Care Model Focus : Pts with chronic diseases DM, HTN, CHF, COPD, PTSD, and Depression Making home the preferred place of care Focusing on the 2-3% of pts whose treatment incurs 20- 30% of health care costs Providing non-institutional support for veteran pts Additional access to care Assisting Veteran self-management of disease (VA,2010)

7. CCHT DEMOGRAPHICS Veteran demographics parallel the relative burden of disease noted in the general public sector. Over 65’s increasing by 1.5% per year (Baby Boomers) Over 85’s increasing by 2.2% per year (Traditionalists/Veteran) Multiple diseases with needs/care mismatch

8. GENERATIONAL CHARACTERISTICS  Independent  Strong family values  Respect for authority  Loyalty  Hard work (Zemke, Rains, & Filipczak, 2000) Traditionalist or Veterans Born between 1922 and 1943 Baby Boomers Born between 1943 and 1960  Optimistic  Value youth  Value health  Personal gratification  Material wealth  Hard work All are soldiers 8 th MP Soldiers – Father & Son (Gerke, 2001)

9. Unacceptable for our Veterans

10. CCHT GOALS Improve clinical outcomes Reduce emergency room visits Reduce hospital admissions Reduce clinic visits

11. Marketing Getting the Word Out Educate PC and our new PACT (pt aligned care teams) regarding CCHT as a benefit to the team Allows smooth clinic flow Reduces walk in traffic Improvement in patient outcomes Educate on ease of consultation process

12. PROCESS OF CARE Needs assessment Finding pts that may benefit from CCHT POTS (plain old telephone service) or other approved connectivity Electric service PC team Good cognitive function or caregiver willing to utilize equipment Meets high utilization, high cost, or high risk for increased utilization due to disease severity Inclusion Criteria

13. High Risk/High Cost/ High Utilization HgA1c 9 or above Newly insulin dependent BP 160/100 on more than one occasion In the ED 2 times in the past year Inpatient 2 times in the past year Compliance issues with medication 10 clinic visits in one yr or 2 specialty providers

14. EXCLUSION CRITERIA Patient does not have a plain old telephone or ability to connect to internet HgA1c or BP not really out of range Patients that decline participation Documented violence or aggression

15. Consultation form

16. QUESTIONS FROM PATIENTS How much does it cost? Will my Dr. still know what is going on? Who adjusts my medications? Does the Telehealth Equipment interrupt my phone service? How does it send you the information? Do I have to do my sessions at the same time everyday? What about vacation? Can I take my spouse’s BP? Do I have to pay for broken equipment or lightning strikes? Can anyone see in my house?

17. The Journey CCHT started – DM NOV 2005 DEC 2005 HTN 2006 COPD, CHF, MH PTSD Palliative Care FY 2010 2007 - 2009 Monitor & Adjust 2011-2012 More emphasis on managing CHF and more mental health patients Looking ahead

18. CCHT MEASURES Care Outcome Measures Lower HgA1c (7 or below) Lower BP (140/90 or 130/80) Process Measures Lower utilization/Inpatient stays 30% decrease meets target 40% exceeds target Increase participation

19. Fayetteville exceeds each enrollment target Fayetteville

20. VISN 16 Bed Days of Care (BDOC) % CHANGE QUARTERLY REPORT FY10 Performance Monitor Scoring:  30% Reduction meets target  40% Reduction exceeds target VHSO continues to exceed the target in reducing BDOC

23. Increased CHF focus Increased Mental Health focus Technology changes WHAT NEXT?

24. Questions ?

25. References: Gerke, M.L. (2001, September). "Understanding and leading the quad matrix: Four generations in the workplace: The traditional generation, boomers, gen-x, nexters,“ Seminars for Nurse Managers 9 173-181. VA, (2010). VISN 16 Distance Health Program Care Coordination Home Telehealth, Operations Manual. Author. Retrieved March 23, 2011 from http://vaww.visn16portal.va.gov/SiteDirectory/diag/cccht/ Zemke,R., Raines, C., Filipczak, B. (2000). Generations at Work: Managing the Clash of Veterans, Boomers, Xers and Nexters in Your Workplace. New York: Amacom.