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Thread: Keeping patients connected

  1. #1
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    Keeping patients connected

    Keeping patients connected
    Technology helps VA reduce hospital visits
    By Alice Dembner, Globe Staff, 9/23/2003

    Richard Keirstead used to rush to the veterans hospital in West Haven, Conn., as many as 10 times a month for crises caused by his diabetes, multiple sclerosis, or advanced heart disease. In 2000 alone, he was hospitalized four times. Now, the 72-year-old Air Force veteran manages much of his care from his Guilford, Conn., home through a computer that measures his blood sugar, heart rhythms, and blood pressure daily and lets him and a Veterans Affairs nurse know whether anything is out of kilter. If there's a problem he can't handle by adjusting his diet or exercise, he can "meet" with a doctor via live video.

    "I'm getting more care, and it saves me trips into the VA," said Keirstead, a Waltham native who has been hospitalized only once -- for a heart attack -- since he got the telehealth system in early 2001. "Eventually, everyone is going to have one of these in their house."

    Based on its success with patients such as Keirstead, the Department of Veterans Affairs is launching the largest telemedicine initiative in the country, planning to bring computer and telephone-based medicine to the homes of 25,000 chronically ill patients nationwide by the end of 2004. Specialists say the effort, if successful, will encourage other health care providers to follow, using technology to help patients manage their own care from their homes.

    "Within 10 years, this is going to be very widespread," said Dr. Joseph Kvedar, director of telemedicine for Partners HealthCare in Boston and president-elect of the American Telemedicine Association, based in Washington, D.C. Partners, which runs the largest health care system in Massachusetts, is testing technology similar to the VA's through its home care program for patients recovering from serious wounds or from heart failure.

    The VA program, which is being rolled out over the next few months, will offer telephone- and computer-based technology to patients, ranging from automated medication reminders and hand-held vital sign monitors to two-way video computers like Keirstead's that are equipped with everything from a stethoscope to an electrocardiogram machine. Participation is voluntary, and patients who prefer to continue with traditional care may do so.

    The sickest VA patients will get a system like Keirstead's, which is programmed to notice any test results that indicate a decline in health. When he plugs his glucose monitor into the computer, for example, the computer alerts both him and a nurse if there is a significant change from normal. At that point, a clinician calls Keirstead to talk about the problem or asks him to come to the office.

    The technology is not cheap: The top-end machines and support systems the VA used in a New England test cost about $7,500, plus about $1,200 a year in operating costs, though other programs that use patients' phones cost much less. Despite such costs, the VA estimated it saved about $2 million on the care of 47 patients in this region over a year.

    The goal of the telehealth initiative is to help patients with chronic diseases stay healthier and out of the hospital, nursing home, and emergency room by catching problems early, thereby freeing up millions of dollars that can be used for other patients. VA officials hope the program will help the overburdened system shorten waits for doctor's appointments and cope with shortages of other clinicians as well.

    "This is a way to monitor the care of patients continuously,"said Dr. Adam Darkins, who oversees the VA's telehealth program. "We want to ensure veterans get the right care in the right place at the right time."

    Patients and their advocates are praising the technology.

    "It makes it easier for the patient," said Tim Jones, a senior field representative for the American Legion. "It keeps their providers more aware of their condition."

    The only downside, doctors say, is the possibility of missing a cue that might have been detected in a face-to-face office visit.

    In a pilot program in Connecticut for chronically ill patients, including Keirstead, the VA found hospital bed days of care decreased 85 percent, trips to the emergency room by 26 percent, and the need for home nurse visits dropped 21 percent, according to Donna Vogel, manager of the home telehealth project in New England.

    "There's always going to be some component of listening, touching, and talking to a patient that you'll need to do in person," said Dr. Joseph Erdos, chief of telemedicine for the VA in New England. "But a lot of the routine data gathering can be better done at home."

    Outside the VA, similar but smaller home telehealth initiatives are being conducted by visiting nurse associations and private medical centers in some states, including Massachusetts. But specialists say the VA's large effort will stimulate faster growth and help bring down the cost.

    "When you have a substantial investment from the VA, it will accelerate the whole field," said Jonathan Kinkous, executive director of the American Telemedicine Association. "The VA will be the largest [organization] to incorporate it as part of their regular plan of caring for patients."

    Throughout New England, a handful of VA patients with spinal cord injuries, who find it hard to travel to the doctor, already are using a similar system and digital camera to help doctors monitor pressure sores and other problems. With these patients, however, the doctor typically schedules a video visit with the patient.

    Dr. Sunil Sabharwal, chief of spinal cord-injury care for the VA in New England, said the connection enables some patients to avoid going to a nursing home. "It's where the future of medicine is going," he said.

    Alice Dembner can be reached at Dembner@globe.com.

    © Copyright 2003 Globe Newspaper Company.


    © Copyright 2003 The New York Times Company

  2. #2
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    sheperd center in atlanta has this program for a year after discharge. the folks in charge of the program are very nice and helpful. we never had to use the service, but it was nice for that first year to have a back-up. course now i know about this site!!!

  3. #3
    Shephard's program is considered a model in this field, although most VA hospitals have had similar programs for a number of years. We have a telemedicine program in the SCI center where I work, and have had it for the last 6 years. This is not really anything new.

    I know Dr. Sabharwal (he is new at the Boston VA) and wish him luck with this valuable project.

    (KLD)

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