Impact
1 - Patients’ condition improvement: - Better quality of life: > 28%, measured by special – SF36 and Saint George –questionnaires - Reduction of re-admission rates and length-of-stay > 60% - Reduction in clinics and emergency room visits > 40% - Significant behavior changes and treatment compliance - Significant increased autonomy, satisfaction and acceptance: estimated by specially designed subjective questionnaires. 2 - Health and social care system decongestion: De-occupying of hospital beds, documentation of costs and avoidance of duplicates among multiple points and levels of care delivery that patients are very frequently subjected to. 3 - Significant cost reduction: - Direct costs (> 60% only from hospitalizations saved) - Indirect and social costs, which although very important, they have not been precisely measured as yet. 4 - Mobilization of all the relevant stakeholders and creation of the critical mass for decision makers’ influence. The above measurements have been made during clinical trials (pre and post, and randomised control studies), with the use of common EU level clinical protocols. Despite these impressive results, we are fully aware of the huge gap existing between R&D/ scientific publications and the everyday practice of the real life. The way is long ahead, that's why we have organised and participated in several national and EU seminars, events, press releases and other open activities. In addition to these, our Unit took the initiative two years ago, to forming the “Alliance for Continuum and Integration of Care†(ACIC) with the participation of all the relevant stakeholders (insuers/payers, major technology and telecom providers, scientific societies, policy makers, local and social authorities, patients' associations and expirienced e-health users). ACIC is a national / international, informal as yet body, acting as a forum for exchanging ideas and removing barriers for the e-Health services adoption. Similarly at EU level, we actively participate in the “Lincare†Alliance (www.linkcarealliance.org), an initiative born in Barcelona from the experience of leading partners in the area of integrated care and supported by multidisciplinary organisations in Europe.
Track record of sharing
Participation in Major EU Events, i.e: - Th. Vontetsianos: “E-health networked services: empowering elderly and chronic patients, increasing output of the health and social care system and improving productivity†E-health high level ministerial conference, May 2005 Tromso, Norway www.ehealth2005.no - Th. Vontetsianos: “Patients' and Practitioners' Empowerment through Networked e-Health Services. Transforming Health Service Organisations in the e-Health Era†Athens, June 2005 www.ehealthAthens2005.gr - A round table discussion Th. Vontetsianos: “Experiences and applications: integral care for patients“ discussing about Experiences in Greece Forum Euromed Salut, Barcelona, Spain, Nov. 2005 www.healtheuromed.net - A round table discussion Th. Vontetsianos (Co-chair and speaker) “Home Based Integrated Care in Patients with Chronic Respiratory Failure with the Use of E-Health Services†Med-e-tel 2006 Luxexpo, Luxemburg www.medetel.lu - Th. Vontetsianos: “New skills of care providers for the emerging e-health integrated home and community care in the new world†E-health high level ministerial conference 2006, Malaga, Spain www.ehealthconference2006.org - “Chronic Disease Management and E–Health Services: Experiences from Good Practices in EUâ€. Round-table discussion at 3rd Panhellenic Congress on Health Management, Economics & Policies, Athens, Greece, December 12-15, 2007 Moderator: Th. A Vontetsianos, Speakers: Alonso Albert, Kohler Friedrich, Pettersen Sture, Skouras Costas, Veliotes George www.healthcongress.gr - P.Giovas “Service Validation: Clinical Trials on the Early Discharge of Respiratory Patientsâ€. Workshop on “Smart Textiles and Service Innovations in Tele-care Servicesâ€, eChallenges e-2008 Stockholm, Sweden, 22-24 October 2008 www.echallenges.org/e2008
Lessons learnt
Lesson 1 - System change. A holistic system change and re-engineering of care delivery proposal is strongly needed, integrating the mutually complementary interplays of tertiary, primary and social care sectors. ICTs can play a major role as enable factors in this new landscape, co-ordinating and optimising the proccesses among the multiple points and levels of care delivery. Although many financial and structural barriers for such a change exist today (political and social agenda, reimbursement schemes, established practices, need for resources reallocation, roles changing etc.), policy makers and thought leaders appear to be more and more convinced of its need, given the social and epidemiological developments in Europe. Sound clinical evidence and close collaboration of all the relevant stakeholders (insuers/payers, major technology and telecom providers, scientific societies, local and social authorities, patients' associations and commited users) are essential for the "critical" mass creation. Lesson 2 - Technology driven programs are bound to fail. Structure follows strategy and technology follows process. A lot of technology-driven projects have failed to deliver the promised results. This is mainly caused by a lack of medical and social vision on how the desired results and benefits will be achieved. Therefore chronic care management processes need to be customizable, rather than being shaped around a particular technology. Only after the desired care process is clear should the right technological support be chosen and implemented from a variety of technologies kept in mind. Lesson 3 - Role of the health and social care personnel. Today’s technology is really impressive but efforts based only on technology are bound to fail. The experience, skills, and diligence of disease and care management professionals will always be critical, indeed essential, to the success of any effort. (Coughlin at al 2006)
Project or service
How?
A most impressive set of results - well done! So others could travel down the same path, could we have details of what was done to achieve these? Many thanks in anticipation
Continued, comprehensive and Integrated care for the patients an
Dear Charles
Thank you very much for your interest and comment.
To our experience, the key factor for the favour results is the combination of the “holistic approach, comprehensive care, proactive follow up and prevention of the deterioration†at each patient.
We used ICTs as an enabling factor to implement in our clinical practice the current principles of Care Pathways and Chronic Care Management. Its basic elements, “Health Record – continuous personalized education and monitoring - information and special knowledge sharing - accessibility and social networking - change in attitude – treatment compliance - deterioration and dependency preventionâ€, would be in practical terms, unattainable otherwise.
Our patient –centric services, supported by specifically designed for each patient’s needs ICT solutions, follow proactively the patient at any step he/she takes in the care delivery system, bridging and empowering all the points of care delivery. They are accordingly organized in the following consecutive phases:
a. Initial self management phase and Web-based Electronic Health Record creation
b. Chronic proactive -home and community- based follow up and support, through real time video, vital signs and information transmission with the use of stationary or mobile and wearable devices
c. Home hospitalization and early hospital discharge, with specially equipped and guided nurse visits, to prevent the hospital admissions and to decrease their duration.
Through these services, holistic care delivery around individual care plans and interventions by multiple collaborating professionals, at the right time and place each time, become feasible in a well orchestrated and cost effective way.?
This kind of services is especially and extremely valuable for the people served by our Hospital. The vast majority of them are socially disadvantaged elderly of low levels of education and income. They usually suffer from more than one chronic condition with serious neglected co-morbidities, various degrees of disability, social isolation and depression. The course of their condition, due to poor control, is characterized by multiple visits and admissions to public hospitals, on which they are exclusively dependent. The situation becomes dramatic, for those living in small islands of the Aegean Sea, when their transportation in hospital becomes impossible, due to weather blocking conditions.
So, a particularly interesting finding of our trial is that the more socially disadvantaged the patients we’re addressing are, the more precious the use of ICTs is. This is something that to my knowledge is not particularly stressed in the literature.
I hope, we'll have the chance to meet personally and continune this conversation
Best regards
Theodore