Patient and Provider Satisfaction/Quality

1. What Evidence Supports the Use of Technologies in Home and Community-based Caregiving of Older Adults?

2. Patient and Provider Satisfaction/Quality Pamela Whitten, Ph.D. Associate Professor Michigan State University pwhitten@msu.edu

3. Agenda • Types of Activity • Brief Overview of Research Findings

4. Categories of Technology-Delivered Care • Data Only • E.g., Telemonitoring for blood pressure (Artinian, Washington, & Templin, 2001) • Video/Audio Only • E.g., Telepodiatry in 200-bed home for the elderly (Corcoran , Hui & Woo, 2003) • Video/Audio and Data • E.g., Telehome health in CA (Johnston, Wheeler, Deuser, & Sousa, 2000)

5. What We Know from Evaluation

6. Satisfaction/Perceptions

7. 1. Patient Satisfaction • Positive responses from geriatric patients living in retirement community who had telemedicine service 1xweek for 8 weeks (Bratton & Short, 2001) • VA Home and Community Care Project in GA, FL, and Puerto Rico reported a 90% satisfaction rate (Meyer, 2002)

8. 1. Patient Satisfaction • Study in Korea (Chae et al., 2001) found that predictors of satisfaction with low-bandwidth telemedicine included: • Location (patients at home more satisfied than patients in nursing homes) • Patient’s perspective on the quality of the communication encounter between the provider and patient (instead of quality of transmission)

9. 1. Patient Satisfaction • Qualitative and quantitative data point to positive patient perceptions • E.g., Home-based TelePsychiatry project (Whitten, 2003) • E.g., Telehome Health in the UP for diabetes and COPD/CHF (Whitten, 2003)

10. Patients Really Like this Service • “a few of the more timid patients tell me that they like having visits via the equipment better than seeing the provider in person because they feel they can say things that the doctor may not like…they feel like they are safe and can say it because they’re not in person” (Whitten, in press)

11. Some patients REALLY like telemed • one woman enjoyed using the telemedicine system because she felt that it would make her appear thinner to her doctor, therefore avoiding a lecture from her doctor about her compulsive eating disorder (Whitten, in press)

12. Telehome health in the UP (Whitten, 2003)

13. 2. Provider Satisfaction • Nurses’ responses varied • significant learning curve among nurses and comfort and ease with technology will come with time (Dansky and Bowles, 2002)

14. 2. Provider Perception • A telehome health study in Minnesota concluded that telehome health providers felt that for 92% of the visits, the televisit would not have been significantly better if performed in person (Demiris et al., 2000).

15. 2. Provider Perceptions • Yet, mounting evidence suggests that providers may actually be the most significant barrier to diffusion of telehome health

16. Provider Perceptions • EX: Telehospice in Michigan • Providers are the main barrier to telehospice • Pre and post surveys found that providers who saw benefit for telehospice from day one were primary users and this never changed.

17. How can we explain this? • Ran series of crosstabs and found no relationships (experience, demographic) • Providers felt they received adequate training and org support • Providers acknowledged benefits and recited office success stories • Preferred to see patients in person • Did not like things they lost with telemed (e.g., mileage, unaccountability)

18. Quality Indicators

19. Clinical Outcomes • Many articles purport to demonstrate clinical effectiveness of telemedicine • Almost all make positive claims

20. Home health study reported improved mean arterial pressure in hypertension patients (Rogers et al., 2001) • The MyCareTeam Website helps people with diabetes manage their disease. A feasibility study of the site showed a statistically significant reduction in HbA1c (glucose control indicator) over a six-month period (Levine et al, 2002).

21. In CHF patients over 65 years of age, telehome health patients demonstrated a 31% decrease in hospital admissions and a 36% decrease in ER visits and a 52% improvement in quality of life scores (Chetney et al., 2002). • In the Kaiser Permanente telehome health project, researchers documented no difference in quality indicators between the telemedicine group and the control group (Johnson et al., 2000)

22. Review Articles Hailey et al., 2002 • Looked at 1300 papers and found only 46 assessed some type of clinical outcome

23. In general • Limited evidence of detrimental effects, unequivocal benefits, or evidence of safety

24. Social Support • Both caregivers and patients perceive enhanced social support.

25. Patient support • Patients credit the telehome health equipment in a Visiting Nurses Association telehome health project with increasing their sense of connection to the staff (Cardoza & Glaskell, 2002).

26. Support • Videotelephony for telehome care…technology addresses several of the special needs and expectations of the elderly in relation to their autonomy, specifically the need to feel a sense of belonging that is often countered by social isolation (Arnaert & Delesie, 2001)

27. Caregiver support • A videophone put in a home of an actively dying patient allowed the patient’s wife to call into the telehospice unit for support on the patient’s last night (Whitten & Doolittle, 2002).

28. Summary of what we know from research to date • Patients often embrace technologies when there is a real need being met • Providers probably hold the key to its use • More outcomes research is needed for definitive answers, but the outlook is positive

29. For further information... • ATA • http://www.atmeda.org • Telemedicine Information Exchange • http://tie.telemed.org • Journal of Telemedicine and eHealth • http://www.liebertpub.com/tmj/default1.asp • Journal of Telemedicine and Telecare • http://www.coh.uq.edu.au/jtt/

30. Telemedicine Books • Ehealth, Telemedicine, and Telehealth: A guide to Startup and Success (2001) Maheu, Whitten & Allen • Telemedicine and Telehealth: Principles, Policies, Performance and Pitfalls (2000) Darkins & Carey • Home Healthcare: Wired and Ready for Telehealth, the Nurses' and Nursing Students' Edition (2003) Kinsella