IGEA SAT

Objectives

The need for home-care is expanding dramatically. People are living longer than ever before in history. Today 18% of the Italian population is over 65 years old and such a percentage will increase to 20% in 2008 (11 million).

They are better educated and are more comfortable with the use of technology. Most people want to remain independent and live in their homes as long as possible, yet a greater number of people are suffering from chronic conditions.

At the same time, the health care industry is facing a critical shortage of public resources, as well as nurses and other health care personnel to care for our population. Health care providers are forced to do more with less resources, with decreasing reimbursements and increased focused on quality and clinical outcomes.

IGEA SAT (Integrated General E-care access for home-care via SATellite) final objectives are:

• To provide added value social services through the most innovative technologies, like Interactive TV and satellite, allowing service utilization by all people, in particular the elderly, in spite of their geographical location. For highly distributed geographical areas including under served and remote areas, the satellite remains the only means to make healthcare services really “universal” and to guarantee the necessary quality standards.
• To support disease management by providing communication and access to knowledge, and by enabling patient self-management. Success with disease management requires delivering the right interventions, at the right time, in the right way, to all the right patients.
• To test the system in the framework of a clinical pilot study aiming to demonstrate the possibility to effectively manage, through telemedicine services, chronic patients at home.

Challenges

• Existing infrastructure and clinical systems were the basis upon which IGEA SAT has been implemented. The project aimed to supplement existing infrastructure rather than replace infrastructure.
• Rollout of the IGEA SAT services was undertaken at the very beginning of the Project to provide at the later stage learning’s from previous implementation and utilization.
• Compliance of all actors to the tele-monitoring system according to the clinical protocol defined for each disease and the improvement of the QoL (Quality of Life) were the initial targets for the IGEA SAT evaluation.
• The pilot operations were carried out as clinical pilot study managed and monitored by a Scientific Committee.
• IGEA SAT seeks to make significant change and be a catalyst for even more change in the way the healthcare services are delivered.

Plan

The project has had a 2 year duration broadly consisting of three phases of activity:

• Design Phase (4 months)
• Build Phase (10 months)
• Deployment and Operations Phase (10 months)

From the utilization point of view, IGEA SAT has foreseen a pre-validation and a validation phase. During the pre-validation phase occurring at the very early stage of the project, a prototyping network has been set-up and used by a small user group (15 patients) to provide feedbacks on the system “usability” and on the workflows and operations procedures. The validation phase, corresponding at the pilot operations, has involved about 105 patients representing all types of identified users.

Current Status

IGEA SAT demonstrated that an adequate mix of pervasive technology, education and training is a powerful tool in a new system of delivery of care.

Best Practice data have shown that chronic patients that are included into well planned and well managed disease management programs (DMP) are complying well to prescriptions with only one quarter “behaving” fairly and almost a quarter behaving “very good” while approx 50% of patients have a good compliance. These programs, where implemented, are an asset for the public health but they are only seldom conducted due to the extensive need of human resources (health professionals) and dedicated clinic space.

The performance of patients in IGEA SAT exceeds the data reported from best practices in Disease Management Programs (DMP) with good and very good compliance (being 30% and 58% respectively) with a satisfactory performance of 88% (IGEA-SAT) vs. 76% (DMP). Moreover, the most important result is the improvement in compliance not only as the total of “good” and “very good” but the shift of patients towards the best performance.

These data support the concept that IGEA-SAT (and IT based health programs) can fulfil the needs for better care and self-care and could well be an alternative to standard clinic based DMPs and, in most cases, the only applicable means of implementation of current health policies.

Patient satisfaction has been good with respect to the provided services: 60% of the participants in the pilot gave the maximum score (5) to the overall service; 88% considered the services useful for the management of their disease; 79% considered the service usability easy enough; 83% considered the service fruition through the television very comfortable; 62% considered the monitoring data representation in a table format simpler to read than in a graphical format (38%); the electrocardiograph is the device most difficult to use (57%) as compared to the other devices. These latter were considered very easy to use in complete autonomy (100%).

76% of the sample were declared to be serene, 17,5% declared to be moderately anxious and only 6% declared to be depressed. In evaluating their own healthcare status, 53% of people reported a stability in their healthcare status, 35% an improvement and only the 12% a worsening of their healthcare status in the last 12 months. Despite the low number of patients included in the study, citizens and healthcare professionals involved in the pilot operations very much appreciated the services and their potential: the possibility to have a Service Centre support 24 hours was promoting a peace of mind for the patients that, eventually, gained a central role in the whole process of the service provision.

Physicians, nurses and physiotherapists well accepted their involvement in a new organizational context even if the implementation of these types of services requires a change of both the hospital and the territorial healthcare services organization that not always has been well accepted by the parties in place.

In IGEA SAT, for example, two clinical centres in Lombardia, initially committed to participate to the project, withdrew their adhesion when they faced this problem; in the Elba island only after several months from the start of the operations, the USL (local health administrative authority) that administers the territorial services through the GPs formalised the availability of a territorial nurse for IGEA SAT, and most importantly, the inclusion of the IGEA SAT services among the ADI (Assistenza Domiciliare Integrata-Iintegrated Home-care Assistance) services. This is an important result of the project that opens a new pattern of opportunities for the adoption of telemedicine to support the delivery of primary care.

In general, an organizational change is a long term process that needs time for the initial roll-out and its complete implementation. The IGEA SAT success stands on both the used technological platform and on the cooperation among healthcare professionals made possible thanks to the sharing of protocols, procedures and methods. In any case the impact of technology on this type of services needs to be reconsidered by proposing solutions that shall be simple to use by patients and that, when this component (technological) is relevant, can be proposed to patients with a critical pattern profile for which a cost-benefits return can be relevant.

The project wasn’t able to perform an economical analysis of the services aiming to define possible remuneration proposals. Nevertheless, Lombardia Region health administration defined a fixed rate reimbursement for the hospitals participating to the project for the actuation of the CPOD rehabilitation pathway through IGEA SAT.