effectiveness of primary care valcrÒnic telehealth program (slides)

1. Effectiveness of Primary Care teleHealth Mortality & Healthcare Consumption Outcomes in Treating High-risk Chronic Conditions: The ValCRNIC Trial Sherman Kong, M.Sc.* BGSE (2014) * fingers crossed

2. The Fuss

3. Prevention Coordination How It Works (and can save 99bn) Monitoring Information

4. The Valencian Context population > 5 million in 2012 (10.6%) High density at 222 people/km2 (vs 93) 16.7% at 65 years old + 2009: Budget of 5.5 bn 4.65 5.31 in Chronic Care Chronic-condition patient consumption: 80% primary care consultations 60% hospital admissions 2/3 of emergency services Agncia Valenciana de Salut at 40% of budget and oversees 24 health departments (34 hospitals, 6 in long-term care)

5. Enter ValCRNIC Sagunto Elche Planning began in 2011. Trial from 2012 2013. 17mn Public-Private Partnership: Largest in EU afte UK W.S.D. Two key interventions: Tracking and Education 2 departments Sagunto and Elche: 11 and 6 PCC, 1 and 1 hospital + SC (250 vs 484 beds) 512 self-selected patients in high-risk profiles :

6. The Tech

7. The Tech

8. The Tech

9. Objective & Data Central research question: Is any indication that teleHealth intervention can produce better health and reduce intensive acute care use? Death counts, A/E Admission & Visits (5 Hours+), Avoidable Hopsitalization Hospital and primary care visitation records: 12 months before and during 1024 controls (all of Valencian region) via distance matching by 4 characteristics: Logistic + ZIP Models:

10. Comparison: Demography

11. Visualize: PC Visitation GP visits Nurse visits

12. Visualize: AH Visitation

13. Compare: Before Trial

14. Compare: During Trial

15. Estimations Intense Acute Care Utilization A/E Admission & A/E Visits of 5 Hours and Over: Binary-choice measure Instrument for decompensation Correct duplicate counts 1|0 = having | not having such visit type Total outpatient visits: likelihood .996 Treatment has a similar affect (insignificant): odd ratio .990 Worst health, more visits: CRG Group 6 at 2.5x CRG Group 8-9 at 4.85x CRG Level = 1.75x Once happened, more lightly to repeat (1.49)

16. Estimations Avoidable Hospitalization Treatment effect counterintuitive: risk aversion? Length of Stay lowers avoidable incidents: one admission stay, unique cases CRG remains predictable Marginal effect for treatment: 0.061 (0.121) Mortality Trial-period outcomes used Treatment effect insignificant but nicer Marginal effect for treatment even less: 0.003 (0.004)

17. Limitation No device transactional data Self-assessed health and other survey results (Zissman et. al 2012) 40 MS patients from Carmel Medical Center, Israel had more positive perception in health distress, cognitive function, social function energy, emotional well-being, pain (median change greater than 5% in 4 areas) Effect by types and intensity of interaction No time variable for control for trend Inconsistent trial duration: minor Lowest: 9 days only 10% less than half of 365 days Insignificant prediction on lower intensive acute care use and death Estimate for other utilization outcomes Survival Analysis, Diff-in-Diff, Cost-Effectiveness Conclusion & Expansion

18. Looking Beyond: 4 Blind Spots

19. Ethnical: Quality of Care, Data Privacy / Ownership Behavioral: Risk vs. Ambiguity Aversions, Conflict in Decision Political: Organizational vs. Biochemical Change Economical: $ + Short (Pilotitis), Evaluation Standards, Reg. Guidelines Looking Beyond: 4 Blind Spots

20. Ethnical: Quality of Care, Data Privacy / Ownership Behavioral: Risk vs. Ambiguity Aversions, Conflict in Decision Political: Organizational vs. Biochemical Change Economical: $ + Short (Pilotitis), Evaluation Standards, Reg. Guidelines Looking Beyond: 4 Blind Spots Behavioral economics

effectiveness of primary care valcrÒnic telehealth program (slides)

Economy & Finance