Momentum telemedicine service descriptions
Objectives, expected outcomes, main beneficiaries
The Cardiauvergne service is for serious heart failure patients (stage III or IV of the New York Heart Association functional classification) who have been hospitalised at least once during the previous year to:
- Improve the prognosis of this disease which is one of the deadliest (5-year survival rate: 31%);
- Reduce the re-hospitalisation frequency of patients (estimated at between 28 and 40% per year);
The service improves the quality of life of these patients and reduces the cost of their care between €15,000 and €20,000 per year.
Targeted population, number of patients
Between 2 to 3 percent of the French population experiences heart failure, and this share of the patient population continues to grow due to both France’s ageing population and better management of acute coronary syndromes. For patients who are aged 60 years or older, heart failure is the primary cause of hospitalisation. In the Auvergne region, the number of patients that is most affected is estimated at 2,000.
Type of telemedicine service
Telemonitoring (“telesurveillance”) was considered in Cardiauvergne because of the geographic and demographic configuration of the region: patients live in isolated areas where there are few healthcare professionals, whether they are general practitioners or specialists in the field of heart failure.
To avoid unnecessary hospitalisations, a telemonitoring infrastructure was set up to perform the following actions:
- Monitor the patient’s daily weight (using connected scales);
- Send the measures to a nurse’s smartphone at intervals depending on the severity of the condition;
- Send the results of medical tests taken by the biology laboratory;
- Send and deal with information provided by the pharmacist.
Information and data are entered into the patient’s electronic health record. An IT system generates alerts or alarms depending on pre-defined parameters. A coordination unit (consisting of two cardiologists, two nurses and one secretary) manages these alerts and alarms. The coordination of various healthcare actors’ interventions (such as those by general practitioners, cardiologists, nurses, pharmacists, physiotherapists, dieticians) contributes to improving care management.
Set-up that was being replaced
Repeated hospitalisations for heart failure, with average lengths of stay exceeding 13 days, were caused by inadequate care paths. There was evidence that better monitoring of patients and their therapeutic education can improve this situation.
The objective of the new service is to improve patient survival and reduce hospital readmissions for heart failure patients. The key idea is to improve treatment by monitoring the patients and their adherence to hygiene and nutrition measures, and to adjust and change the treatment quickly if needed to avoid hospital readmission. Patient education is ensured by phone contact and by making ad-hoc appointments at the nearest pharmacy.
Outcomes and results expected after introduction
An initial assessment was carried out on the first 558 patients after two years of operation (the average length of monitoring of each patient was 355 days):
- Mortality was reduced by 12 % per year (which is double compared to classical patient monitoring);
- The rate of re-hospitalisation for patients with new onset of heart failure is reduced by 13.6 % per year, with an average length of stay of 9.2 days (as compared to 13 days before).
The priority of this new service is to entrust telemonitoring tools to patients and make patients more active and involved agents in the management of their condition. Therefore, it is essential that these tools are easy to use.
The following factors have guided the implementation of the service and certainly contributed to its success:
- Involving the patients has helped the patients to “own” their condition.
- The simplicity and convenience of the monitoring solution (a single connected scale) has strengthened acceptance on the part of both patients and healthcare professionals.
- The service contributes to overcoming institutional barriers between the two services of general practice and hospital medicine. It supports healthcare professionals’ new modes of practice. Over the period analysed, 444 general practitioners, 95 cardiologists, 76 biologists, 355 pharmacists and 980 nurses joined the health coordination group.group.
Cardiauvergne is one of the most nationally known telemedicine services in France. It offers a new mode of care coordination that is proven to be effective and inexpensive. It respects the role of local professionals who have accepted the service well. Its deployment is at a regional scale (the Auvergne region gathers together four French departments).
The service should soon be replicated in other regions.