Elizabeth A. Krupinski, PhD Arizona Telemedicine Program

1. Elizabeth A. Krupinski, PhD Arizona Telemedicine Program

2. Recipe for Success: Skill Sets Home TH • Leadership Potential Equation

3. Pelligrino & Cobb 2005 • Recipe for Success: Skill Sets Home TH • 5-Factor Personality Model

4. Pelligrino & Cobb 2005 • Recipe for Success: Skill Sets Home TH • VA Skill Sets

5. Technical feasibility • Provider & patient acceptance/satisfaction • Cost effectiveness • Outcomes = equivalent or better than traditional • H.R. 6331. = 1/1/09, skilled nursing facilities, in-hospital dialysis centers & community mental health centers = originating sites for Medicare reimburse

6. Successful Telenursing • COPD HH vs TN • Pare et al. 2006 • 7.5 vs 4.2 home visits • 46.6 min vs 57.5 min • 40% vs 5% hospitalizations • 7.3 days vs 13.5 days • $2,779 vs $2,424 per patient over 6 mo • Attitudes overall positive

7. Successful Telenursing • Diabetes • Chumbler et al. 2005 with VA • Pre vs post TH enrolment • 50% reduction hospitalizations • 11% reduction ER use • 3.0 fewer bed days of care • Overall improvement QOL, pain reduction & social functioning • Other studies show HbA1C improvement

8. Successful Telenursing • Acute infections • Chronic respiratory failure • Lung transplant recipients • Stroke recovery • Asthma self-management • Cystic fibrosis • Chronic heart failure • Spinal cord injury • PTSD & TBI • Mental disabilities (schizophrenia, Alzheimer’s) • Pediatric, adult & geriatric populations

9. Cancer patients with ostomies being discharged earlier after surgery • Reduces time proficient in self-care • Increases need for education & support visits by nurses after discharge • Distance & time can be considerable • Shortage of nurses specializing in ostomy care

10. Achieving self-care is a process • Nurses guide patients from dependence to independence • Start with total care & conclude with education & support • Telemedicine can serve a role in this process at all stages

11. Methods - Subjects • 28 patients with ostomies resulting from treatment for cancer • 14 HH =11 urostomy, 3 colostomy • 14 TH/HH = 7 urostomy, 7 colostomy • LOS = 8.86 days HH; 8.36 days TH • 68% male, 32% female • Mean age = 66.5 yrs (sd = 9.68) • 89% Caucasian, 7% Hispanic, 4% AfAm

13. Methods - Subjects

15. No significant differences

17. Surgery: t = 0.304, p = 0.7632 • Discharge: t = 0.170, p = 0.8666

18. Ostomy surgery explained = 100% • Enterostromal nurse participated care = 96% • Family of support during surgery = 100% • Received United Ostomy Association visitor during hospital stay = 38% • Who helped adjust to surgery • Family = 36% • Ostomy nurse = 36% • Doctor or nurse = 22% • Other = 6%

19. Colostomy Significantly > Urostomy

22. *Set fee for HH visit **30 min 0.04/min airtime = $1.20 + $17.70 salary *** TH only vs HH t = 5.05 p = 0.0001

23. E-ICU Efforts Pereira et al. IMEDIR in Spain ICU filled with info Need to organize

24. E-ICU Efforts • Avera eICU (South Dakota; Pat Herr)

25. E-ICU Efforts • Avera eICU (South Dakota; Pat Herr)

26. E-ICU Efforts • Sutter Health eICU (CA; Teresa Rincon) • Onsite intensivist coverage 12 hrs/day = $43,810 • RN resource for APACHE & se[sis data collection = $11,700 • Licensing fees for risk adjusted data collection = $1800 • Total costs per bed onsite = $57,310 • Total costs per bed eICU = $42,000

27. Remote monitoring & wearable devices • Wellness & prevention devices • Call-centers & automatic monitoring • Smart homes • Business-based programs • All have TH Nursing component • Need to be evaluated further for impact & health outcomes

28. Telenursing occurs on a variety of levels & in many environments • Clear cost & outcome benefits have been demonstrated • Opening avenues for reimbursement & new care settings • Providers & patients will continue to benefit from telenursing expansion

29. THANK YOU!