Home monitoring of chronic diseases

Delivering healthcare via telecommunications could open up home monitoring of aged care patients with chronic diseases, improving health outcomes and significantly saving costs.

The Challenge

The cost of delivering healthcare is increasing

Managing the rising cost of delivering healthcare is a major challenge for Australia.

Targeting health services to assist the chronically ill and ageing population – which accounted for over 70 per cent of Australia's $103.6 billion health expenditure during 2007-2008 – can help to reduce the load on our health system and hospitals.

'Frequent flyers' are high cost patients to the health system, who typically have a combination of complex medical conditions such as lung disease, cardiovascular disease or diabetes and visit the hospital two or more times per year.

Our Response

Monitoring patient care using telehealth

Clinician showing a patient how to use the home monitoring system.

Funded by the Australian Government Telehealth Pilots Program and CSIRO, we built on our e-health expertise and partnered with NGOs, local health districts, hospitals and industry partners TeleMedCare, iiNet and Samsung to deliver a national telehealth trial of home monitoring of chronic disease for aged care.

Trial partners across the country including ACT, Townsville, Bacchus Marsh & Melton, Launceston and Greater Western Sydney meant this was Australia's first large scale telehealth clinical trial.

In total 287 patients participated in the trial across the six sites. Test patients were provided with a telehealth device that included participant/clinician video conferencing capabilities, messaging features and the delivery of clinical and study specific questionnaires, as well as vital signs devices to monitor their ECG, heart rate, spirometry, blood pressure, oxygen saturation, body weight and body temperature, with glucometry an optional add-on.

The 12-month trial enabled chronic disease patients to self-manage their conditions at home through the provision of telehealth services. Health workers could assess changes in their patient's conditions remotely and provide appropriate care interventions earlier to help them stay out of hospital and improve their quality of life.

Managing chronic disease at home using telehealth

Show transcript

[Music plays and text appears: Managing Chronic Disease at home with Telehealth]

[Image changes to Professor Branko Celler, Research Leader, CSIRO]

Prof Branko Celler: The population is ageing. Those aged over 65 will double and those aged over 85 will quadruple in the next 20-years.

[Image changes to show an ambulance reversing into a bay]

Chronic disease at present consumes over 70 per cent of the total healthcare budget and is growing so rapidly that it could consume all of the States budgets within 20-years.

[Image changes to show patients being treated inside a hospital]

Telehealth is one of the best ways of trying to reduce hospitalisation, therefore, hospital costs.

[Image changes to show an elderly man blowing into a mouthpiece with his results being displayed on the Telehealth monitor]

The Telehealth system is basically a monitoring system with quite a large screen to help guide the patient through the different procedures.

[Image changes back to show monitor now on a Blood Pressure screen and the elderly man is entering information into it]

Typically, the process takes 20-minutes. Patients take their blood pressure, they record their blood oxygen, their blood glucose, their electrocardiogram, their body temperature, their body weight and they answer a number of clinical questionnaires.

[Image changes to show an elderly lady with a thermometer in her mouth and then back to the monitor which now reads Measuring]

This data is then gathered and sent off, almost immediately, to a remote website to become visible to the care team.

[Image changes to show a member of the care team, Lay, reviewing the results of the patients’ tests on a computer screen]

The data is collected in real-time and can be viewed almost immediately, particularly for patients connected to a broadband system.

[Image changes to show Lay Yean Woo, Diabetes Nurse, Djerriwarrh Health Services]

Lay Yean Woo: I monitor my clients once a day and looking at reviewing all the data entries that have been transmitted to me. It is quite straightforward and it is a very easy process. I can see the information in real-time, I can monitor them, following up with a phone call if there’s any issues with their health.

[Image changes to show Lay on the phone with a patient giving results: “Your blood sugar levels is looking a lot higher this morning”]

Also with the time that has been freed up for me I can look at more new clients being referred to me.

[Image has changed back to Professor Celler]

Prof Branko Celler: The trial targets chronically ill patients that have complex chronic conditions that tend to take them to hospital multiple times a year.

[Image changes to show Lay assisting an elderly man entering data into the Telehealth system]

They begin to self-manage and this is really important, because this has been demonstrated to be very effective in helping to keep patients out of hospital. So the patients are a key player in the total management of their chronic condition.

[Image has changed to show Bill and Janice. Text reads: Janice’s Husband and Carer]

Bill: I jumped on it straightaway, when Lay came to me and said would we like to do it? And there was no hesitation. Before she was going to the doctors two or three times a week and now she only goes once every three weeks.

[Image changes to show Bill performing a finger prick test on Janice and entering the results into the Telehealth system]

And with the help of this monitor I don’t get so scared anymore.

[Image has changed back to Janice and Bill and then shows Bill walking two dogs]

Before I was wondering if it’s safe to leave the house, because many times I’ve come home and she’s been laying on the floor, or she’s injured herself.

[Image has changed back to Janice and Bill]

And it takes a lot of pressure off your GP. This way you don’t need to go down there if it’s only something minor.

[Image has changed back to Professor Celler]

Prof Branko Celler: If Telehealth is to be scaled up nationally we need to have a way of being able to identify changes in patient health status on a daily basis. CSIRO’s developing some very interesting new tools to facilitate this, and to allow nurses to understand the patients’ condition on a day by day basis.

[Image has changed back to Janice and Bill]

Bill: I can’t thank her enough for what she’s done for Janice and what the machine has done.

[Music plays the CSIRO logo appears on screen with text: Big ideas start here www.csiro.au]

Hide transcript

The Results

Home monitoring saves healthcare dollars and patient lives

Our research showed savings of 24 over the year to the healthcare system made through falls in the number and cost of GP visits, specialist visits and procedures carried out. Patients in the trial also reported improvements in anxiety, depression and quality of life, with many finding that home monitoring gave them a better understanding of their chronic conditions.

In addition the trial also showed a substantial 36 per cent decrease in hospital admission and most importantly a 42 per cent reduction in length of stay if admitted to hospital during the 12 month trial. This is a huge saving when you consider the cost of a hospital bed per day is estimated to be about $2,051 in Australia.

Patients also had a reduced mortality rate of more than 40 per cent.

Our research showed the return on investment of a telemonitoring initiative on a national scale would be in the order of five to one by reducing demand on hospital inpatient and outpatient services, reduced visits to GPs, reduced visits from community nurses and an overall reduced demand on increasingly scarce clinical resources.

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