Telehospice in Mid-Michigan: Lessons from a Challenging Environment

1. Telehospice in Mid-Michigan: Lessons from a Challenging Environment Pamela Whitten, PhD Michigan State University

2. Telehospice: What We Know Former Project in Michigan Multiple Data Collection Strategies Utilization logs, decline surveys, nursing notes, cost frame, patient and provider surveys and interviews, focus groups, videotapes of telehospice visits Subjects N=189 patients N= 51 caregivers N=51 providers

3. Telehospice: What We Know TM was adopted more readily and demonstrated more significant contribution for rural patients Timing for offering telehospice is a key issue Many end-of-life services can be delivered, nursing dominates Wide array of physical assessments efficacious Activity via telehospice mirrors traditional activities Patients comfortable with services Caregivers untapped source of services Providers make or break success

4. Current Project Overview POTS videophones placed in hospice patients� homes Augment traditional hospice services Two research partners in Michigan, covering urban and rural areas Focus on relieving burden on nurses and improving quality of life Insert project into normal routines�no disruptions

5. Research Themes Care access/utilization Patient and provider perceptions of tech. Outcome influence (costs; types of services delivered via telehospice; quality of life for staff, patients, families; reduce emergency care) Increase provider comfort with technology

6. Research Themes Specific focus on populations: Elderly couples with one patient, one caregiver Rural patients 25+ miles from facility Grieving families On-call nurses Lung disease patients Provider issues with technology

7. Current Data Collection Regular call logs Surveys: (e.g., pain, burden, q.o.l., comfort with tech.) Nursing notes Provider interviews and surveys

8. Initial Interview Themes Administrator: excited about reducing staff burdens, costs; �This could really help our Clinton County (rural area) staff.� Nurses: willing to try; on-call pair thrilled with idea of improved access Physician: fascinated with possibilities Social worker: expectation that human contact through video will improve patient q.o.l. No shortage of enthusiasm all around

9. Key Issue Telehospice is still bumpy � not easily made ubiquitous part of care

10. Opening Bumps Hospital IRB confused by idea of telemedicine in hospice Multiple training sessions cancelled b/c of weather concerns Responsible administrator disappears Higher-level management failed to process paperwork

11. Opening Bumps Initial rural patient on poor-quality phone exchange Some hospice phone lines move to digital system�conflict with POTS equipment Patient level drops unexpectedly Key nurses take sick leave

12. Lessons for Future Planning/Projects