PS4-14 NEW MODEL OF HEALTHCARE DELIVERY: TELEHOMECARE PROGRAM FOR HEART FAILURE (HF) AND CHRONIC OBSTRUCTIVE PULMONARY DISEASE (COPD) PATIENTS IN ONTARIO, CANADA

Tuesday, June 14, 2016
Exhibition Space (30 Euston Square)
Poster Board # PS4-14

Valeria E. Rac, MD, PhD1, Yeva Sahakyan, MD, MPH2, Nida Shahid, HBSc., MSc (c.)2, Aleksandra Stanimirovic, MSc, PhD (candidate)2, Iris Fan, BA1, Welson Ryan2 and Murray D. Krahn, MD, MSc3, (1)Toronto Health Economics and Technology Assessment (THETA) Collaborative, Toronto, ON, Canada, (2)Toronto Health Economics and Technology Assessment (THETA) Collaborative, University of Toronto, Toronto, ON, Canada, (3)University of Toronto and University Health Network, Toronto General Research Institute, Toronto Health Economics and Technology Assessment (THETA) Collaborative, Toronto, ON, Canada
Purpose: Piloted  in 2007, the Telehomecare program supports patients with heart failure (HF) and chronic obstructive pulmonary disease (COPD) using coaching and remote monitoring. The purpose of this descriptive study is to evaluate the overall patterns of program use and patient and service level characteristics. Study population includes HF and COPD patients enrolled in Telehomocare in the Central West (CW), North East (NE) and Toronto Central (TC) Local Health Integrated Network (LHINs). 

Method(s): Data from July 2012-2015 was extracted from the Patient Management Monitoring System (PMMS) database.   Continuous variables were described using median and interquartile range, and compared across three LHINs using a one-way analysis of variance ANOVA or Kruskal-Wallis test. Categorical variables were described using contingency tables and compared using Chi-square test.  

Result(s): Since its launch in 2012, 6370 participants were referred, out of which 4036 enrolled in the program. Highest enrollment rate was reported in CW (78.3%), followed by NE (63.8%), and TC (55.7%) LHIN.  As per program definition, 557 (57.7%), 535 (52.5%), and 590 (4402%) patients were ‘successfully discharged’ in the CW, NE, and TC LHINs respectively. Average age of patients was 74.5±11.2, 52% were women and 56% were HF patients . Overall, 40% patients had diabetes and 57% lived with hypertension. Over 85% of patients were taking five or more medications. Upon enrollment, weekly coaching sessions were planned for 80-90% of patients. However only 9% of patients received weekly coaching, 26% received 2-3 sessions/month, and rest of the patients received 0-1 session per month.

Conclusion(s): Telehomecare users are elderly with high prevalence of diabetes and hypertension, taking five or more medications. Considering half of patients successfully completed the program, our current focus is on studying factors that may impact unplanned discharge rates. Conclusions regarding low numbers of coaching sessions are speculative because of problematic documentation.,

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