US telehealth reduces elderly hospitalisation rates by 86%
A US telehealth programme, run by Olmsted Medical Center, Minnesota, based on wearable tech and sensors, has reduced hospitalisation rates by more than 86%, a saving of around $7.4m. The Living WellatHome system, in partnership with the Evangelical Lutheran Good Samaritan Society, aims to keep patients in the "place they call home" for as long as possible, and combines "connected vitals monitors, calls with a care center, PERS devices and infrared sensors in the home" to monitor a patient's behaviour. Should an emergency arise, the care coordinators can act accordingly.

Olmsted Medical Center, a small health system in Rochester, Minnesota has been running a healthcare at home program for aging patients since 2008. But more recently they started working with the Evangelical Lutheran Good Samaritan Society’s Living WellatHome program to more closely monitor some of those homebound patients using sensors and wearables, and it's leading to better managed care and reduced hospitalization rates.

“What do we want to do with Living WellatHome?” Living WellatHome director Sherrie Peterson asked at the mHealth and Telehealth World event in Boston last week. “For us, the opportunity is to help people stay in the place that they call home. Partnering with their primary care doctor, we’re hoping we can help them to do that even longer whether they’re on the family farm, whether they’ve moved into an apartment, or made a transition to assisted living facility. Wherever that may be, we can take those services to support that patient at home.”

The program uses a combination of connected vitals monitors, calls with a care center, PERS devices and infrared sensors in the home that track movement without violating the user’s privacy the way video or audio recording would. They work with seniors who have multiple chronic conditions.

“We may look at someone with congestive heart failure, and the doctor has set parameters for what they want for weight gain,” Peterson said. “Well, sometimes before we even see the weight gain we’ll see a shift in that person’s sleep pattern, their movement around their home, their bathroom visits. So it’s like playing the game of Clue sometimes. We gather the different pieces from the technologies in the patients home and our team starts to put it together to really understand the mystery of what might be going on.”

The Living WellatHome team always checks in with a patient before jumping to conclusions to avoid false positives, Peterson said. For instance, sometimes the team might be tempted to conclude from the sensors around the bathroom that the patient has a UTI, but they could just have a houseguest staying with them. They also have optional medication reminder phone calls and are investigating different connected medication dispensing devices.

So is it working? Lois Till-Tarara, VP of Clinical Operations at Olmsted, said that while the objective data is still piling up, the anecdotal evidence is strong.

“It’s hard to quantify all the positive things that happened to patients as we were going through this process,” she said. "Our care coordinators tell the stories of lots of happy patients and family members because of near-misses that were caught and care that was elevated to the appropriate level.”

That said there was some hard data, both in comparing the Living WellatHome group to the rest of their home health patients and in comparing them to historical data and projections. Patients using the program had more controlled A1C and blood pressure. On average, they spoke with their care coordinator more often and had more office visits, but fewer visits to the emergency department.

“Looking at statistical probability, how many hospitalizations could we have expected in this population group if they had gone with no intervention, no treatment, the average would be 172. We realized 23,” Till-Tarara said. “That’s an 86.7 percent reduction in realized versus expected hospitalization rates. If you start to look at charges for individuals, potentially you could have saved more than $7.4 million in healthcare charges to the system.”

Perhaps most promising were their engagement rates, showing that 94 percent of patients interact with the technology and report in their vital signs every day, compared to less than 25 percent in a 2014 national survey of patients in telehealth programs.

“Do we use better gizmos and gadgets? I’d say no,” Till-Tarara said. “We use very good equipment, FDA-approved equipment. But it’s really about the service around it. It’s the monitoring team and relationships we have with individuals we monitor. … If someone doesn’t take their vitals, they’re going to expect a phone call. Someone’s going to check on them. And we’ve had some of those early catches because maybe they were too sick to take those vitals.”