Care Coordination and Technology

1. Care Coordinationand Technology Rita Kobb MS, MN, GNP Lead Care Coordinator Tech Care Coordination Program rita.kobb@med.va.gov

2. VA InitiativeCommunity Care Coordination Service Implemented April 2000 Served over 2000 veterans Home is site of care Right care, right place, right time Coordination not care provision Patient not problem focused

3. Why Use Technology? • Increases access to care • Improves communication • Promotes healthier behaviors • Promotes self-care • Reduces healthcare consumption • Reduces healthcare crises

4. Types of Technology • Disease management tools • Messaging devices • Real time video monitors • Computers with chat rooms • Instamatic cameras

5. Technology Devices

6. Risk Management Software

7. 12 mos Pre-enrollment 9 admissions 97 days in hospital 48 ER visits unable to leave home 12 mos Post- enrollment 2 admissions 7 days in hospital 5 ER visits Army reunion Case Study 1-Telemonitor77 y/o WW II VeteranLung Disease from Smoking

8. 12 mos Pre-enrollment 10 admissions 113 days in hospital 37 ER visits no activity wife at home 12 mos Post- enrollment 0 admissions 0 days in hospital 2 ER visits gardening wife out shopping Case Study 2-In-home messaging80 y/o WW II VeteranHeart Failure

9. 12 mos Pre-enrollment 5 admissions 36 days in hospital 12 ER visits wound for 16 mos on surgery schedule 12 mos Post- enrollment 0 admissions 0 days in hospital 0 ER visits wound healed 6 wks no surgery Case Study 3-Camera64 y/o Korean War VeteranDiabetes

10. Lessons Learned • Patients embrace technology • Patient needs/coordination not technology drive care Always include caregivers Don’t use the word computer to explain what technology is

11. Where Do We Go From Here? • 5 Networks (14 states) active • 6 more to begin this Fall • Final 10 Networks Fall 2004 • National training center to teach staff how to use technology and do care coordination opens 2004