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Committment
We are committed to providing the means where medical costs can be
better contained, and patient health can be improved by facilitating the medical
community’s ability to take a more proactive approach to allocating medical
resources and patients becoming more engaged in managing their own care.
Goal
The goal in this approach is to routinely and quantitatively capture patient
health correlated parameters for use by healthcare provider to guide the patient
to the best possible health status, to detect health management problems at the
earliest possible stage, and for use by the patient for objective and
quantitative self-management
Considerations
According to the Centers for Disease Control and Prevention, chronic disease
accounts for 75% of the nation’s $1.7 trillion medical care bill. Heart failure
costs alone represent $28.6 billion of that total. Health care facilities around
the country are seeking solutions that will not only decrease costs of treating
chronic care patients but also improve patient care and safety
Patients with cancer and heart failure experience an unacceptable level of
symptoms as the disease progresses. Inadequate management of these symptoms
results in frequent unnecessary hospitalization and poor quality of life.
However, a validated instrument for assessment of symptoms in this patient
population is required.
Lack of adherence to prescribed medications is the major cause of preventable
hospitalizations, mortality, excessive medical costs, and poor quality of life
in patients
with heart failure.. An important first step to improving medication adherence
is determining the factors that affect adherence. Researchers have demonstrated
that attitudes, knowledge, and barriers to medication adherence are associated
with poor medication adherence. However, few instruments are available for the
measurement of attitudes, knowledge, and barriers to medication adherence.
Depression in patients with heart failure commonly goes undiagnosed and
untreated possibly because instruments available for clinical depression
screening are long and hard to administer. An instrument for ongoing tracking is
required.
Solution
Healthcare providers should utilize the best current technology to improve the
quality care of their patients, while improving their own professional and
financial return on extending healthcare services.
The Process
We
have developed an interactive voice response (IVR), web
administered, software solution that combines patient self-monitoring response
input with touch-tone telephones, or web survey, to follow outpatients who have
symptoms that need to be monitored closely. This IVR/Web system is ideal for
capturing the time course and severity of symptoms in clinical research.
Patients on study can be proactively monitored, even on a daily basis, during
and after treatment for a variety of treatment regimens.
The IVR is simple to use, even for elderly and very sick patients. The system
calls patients at their convenience on a preset schedule; patients then use
their telephone keypad to rate (on a scale suited for your survey) and record
their responses to survey based symptom items. Information about symptoms that
exceed a predetermined threshold value can be forwarded via e-mail, fax or pager
alert to the patient’s health care team to review and potentially to act upon.
Because the IVR calls the patient, missing data is minimized.
Survey information can be used to generate information on symptom clusters and
fluctuation in symptoms that yield longitudinal data for modeling either with
time (trajectory of treatment) or treatment-related events (e.g., onset of
complications). These models can then include longitudinal assays of biologic
events (e.g., changes in inflammatory or other biologic variables) or host
variables (genotyping) that suggest symptom-biologic associations. The system
can also track response to clinical trials with a symptom modulation intent.
Our Clients agree:
We could
not have been able to monitor our cancer patients, follow their
treatment symptoms and provide the immediate response when they required
it without both an IVR (automated out-calling) and Web solution.
Our study helps the physicians know which treatments are working, and
gives the patients a way to reach us when they need it, plus the
patients are more likely to be honest on an automated survey. It
removes the influence factor that is inherent in telephone calls.
There is
no reimbursement for a nurse making these calls, and therefore we could
not fund the extra person that it would take to keep up with the 150
patients that we are monitoring.
We monitor the
patients on varying schedules, which we set up on the web portal.
The system lets us know when a patient requires a follow-up call (email
or fax). This has helped us provide better care, lets the patients know
that we care, and therefore has provided better results.
They can elect to
receive their phone survey and set their day/time, they can call in to
take the survey, or they can choose to take the survey on the web.
Most choose to do the survey over the phone, using their keypad to
answer the survey questions.
Susan K. Schlundt RN BSN OCN
Symptom Management Group
Indianapolis, IN
For more information:
P4P: Participation now may pay off later
CSI Web Builders - Content Management
Surveys and Outpatient Monitoring
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