Enabling Technologies for Home Care: Brief Overview and … · 2010. 6. 30. · Home Guardian LLC Copyright 2007, Home Guardian, LLC 4 How did we get here? Recognized impending surge

Home Guardian LLC

Copyright 2007, Home Guardian, LLC

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Enabling Technologies for Home Care:Brief Overview and Research Results

Steve Kell-Home Guardian, LLC

Home Guardian LLCCopyright 2007, Home Guardian, LLC

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Introduction

� Steve Kell

� Doing research in field for seven years

� General Manager of UVa Medical Automation Research Center 2002-2006

� Part of a team of inventors of several elder useful innovations

� Home Guardian, LLC is the translational vehicle of the research


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Background Environment

Care Providers Payers

Technology Based Companies

Resident needsStaffing needs

Future care modelsUser centered designApplied technology

Evaluation of processes


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How did we get here?

� Recognized impending surge in eldercare demand

� Existing technology approaches miss mark

� Less expensive but more effective means for delivering care are desirable

� Very clear that solutions for unmet needs must be created, validated and implemented across large senior populations


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Agingtech.org


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CAST website


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CAST 2


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CAST 3


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CAST 4


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CAST 5


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CAST 6


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CAST 7


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CAST 8


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What’s Available?

Source: Enterprise Institute report 2007


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Model for Technology-Enabled Care

Older AdultData

Service Provider

Adult Child

Physician

Services

Personal Health Maintenance

Preventive Interventions

Improved Communications

Inference, Archiving,

and Analysis


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尿糖尿蛋白

·Body temperature·Pulse·Blood Pressure·Body fat percentage

Vital Sensor

Data management PC ・ Urine protein・ Urine glucose

Urine analyzer

Home network

Healthcare providers

Home-Health Networked Medicine:Detailed Information But Expensive


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Solution: A New Paradigm in Geriatric Care

Picture credit: www.low-vision.org/ rehabilitation.html

Proactive, Preventive, Personalized, Passive Health Paradigm


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What is HG’s Technology

� Passive physiological and wellness monitoring technologies and longitudinal data analysis and reporting tools for:� Emergency and safety monitoring

� Objective functional and health status assessment

� Care planning and coordination

� Chronic disease management

� Monitoring efficacy of interventions


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What is HG’s offering?

� A series of passive health and wellness monitoring hardware backed by inference engines and data analysis tools/ services

� The tools bring a game changing paradigm in eldercare

� The ADL monitoring, bed monitoring and fall detection are undergoing productization and roll-out.


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Automated ADL / IADL Inference

Validated and detailed methods for the automated inference of all of the ADLs and all but one of the IADLspassively from sensors embedded in the environment.

A generalized method to monitor multiple individuals is pending filing.

Validated and field tested; ready for productization.


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Passive Vital Sign Bed Monitor

Validated system and methods for the passive measurement of physiological signals:

� Heart rate

� Breathing rate

� Movement

� Body surface temperature

� Detecting apnea

� Sleep quality assessment.

Eldercare version validated and field tested; ready for productization.


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A System and Method for the derivation of basic gait characteristics and the detection of falls based on sensing floor vibrations:

� Measures step count and pace

� Measures walking velocity, step and stride lengths

� Detects falls

Fall detector has recently been refined, and validated; ready for field testing.

Passive Gait Monitor and Fall Detector


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Single Platform; Multiple Sensors

Our concepts are:

� Validated

� Most have been field tested

� Passive

� Low cost

� Wireless

� Retrofit to existing structures

� Use phone line to communicate data

� Affordable for eldercare service providers


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Creating the Fall Sensor

Home Guardian LLC


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Accessing and interpretation

Internet Reports


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Turn data into actionable info


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Opening screen


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Rapid status check


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Drill down for detail

Home Guardian LLC


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Restlessness Index Graphs


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Three residents 24 hour reports from June 5, 2005.


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Resident #1012 Slept soundly in the wee hours with a bathroom visit at 2AM (is that why they are called the wee hours?) up and about at 6.


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Resident #1021 shows many bathroom visits at night, much time in bed.


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Resident #1018 was restless much of the night, and has more bathroom visits throughout the day and much less general activity than #1012


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First Pilot

� 22 systems based on MARC technology were placed in residences of a St. Paul, MN area assisted living facility

� The pilot study examined the technology’s installability, scalability, usefulness and impact on both caregivers and older adults in a well controlled environment

� Pilot study ran for 3 months (November, ‘03 – January, ‘04)


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Conclusions from Pilot I

� The monitoring system is scalable and easy to install

� It was accepted by older adults

� The alerting sub-system required refinement

� The monitoring technology improved the quality of life of the monitored individuals

� The system worked and was useful for care coordination and planning, including preventive care

� Caregivers became dependent on the reports in daily care planning


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Second Pilot

� Two assisted-living cohorts� Monitored by MARC technology � Unmonitored age, gender, and health matched control group in separate facility

� Tracked several health related parameters of both cohorts

� Study period April 1st-June 30th

� Monitored cohort (n=21) had a total of 47 doctor visits, including 2 ER visits, and 1 hospital visit, with a mean of 2.24 visits per subject

� Control cohort (n=21) had 73 doctor visits, including 11 ER visits, 4 hospital visits and 1 urgent care visit, with a mean of 3.48 visits per control subject (SD=2.676)

� A paired t-test for means yielded a two-tailed P value of 0.0403, which is considered significant


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Conclusions from Pilot II

� The monitoring technology enabled preventive interventions

� This study shows that the appropriate utilization of the technology could result in cost savings to payers

� The technology did not increase non-billable interactions via fax/ phone with the physician/ health care provider

� Monitoring may have improved professional caregivers’ efficiency and decreased their workloads.


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Results from Other Recent Pilots: Home Health

� Statistically significant increase in perceived quality of life of monitored individuals after 4 months of monitoring (13 older adults)� The increase may have been due to the availability of monitoring reports to professional and informal caregivers which led to improved quality of care evidenced by a decrease in the number of combined physically and mentally unhealthy days

� Statistically significant decrease in caregiver strains of informal caregivers possibly due to peace of mind provided by the monitoring reports


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Results from Other Recent Pilots: Independent Living

� Statistically significant increased in the number of informal care hours, without any increase in strain/ burden levels, or decrease in informal caregivers’ quality of life

� There was no appreciable impact on the quality of life of monitored individuals, possibly due to the absence of professional interventions (unlike the case in assisted living and home health).

� This highlights the important role of professional caregivers, and care providers


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Health Outcomes Study


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Hospital and ER Stays

0

5

10

15

20

25

30

35

Hospital ER

Day

s No Monitoring

Monitoring

N=21 in each group, P<0.004


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Doctor's Visits and Billable Events

010

203040

5060

7080

Doctor Hospital ER

Vis

its a

nd E

vent

s

No Monitoring

Monitoring

N=21 in each group, P<0.04


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Communication Frequency

5456

586062

6466

6870

Calls and Faxes

Num

ber

of C

alls

and

Fax

es

No Monitoring

Monitoring

N=21 in each group, P>0.05

4/1/05 – 6/30/05


45N=21 in each group, P<0.05 statistically significant

Overall Cost of Care Comparison

67,757.88

17,407.02

0

10000

20000

30000

40000

50000

60000

70000

80000

Dol

lars

$ No Monitoring

Monitoring

$67,757

$17,407

Cost of Care to Payer


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Participants speak out about the research in Spirit*, Winter 2005

I feel safer and more secure,” said a resident in

the memorycare unit

“I really like this system,because it enhances the ability

of the staff to provide quality care.I like the idea that my mother ismonitored 24 hours a day. Thatthe staff can look at the data andinstantly see if something is out ofthe ordinary. It was because of thesystem, that they could see that shehad a urinary tract infection, andwith early intervention cleared itup,” a family member said.

*Spirit is a publication of Volunteers of America National Services


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More comments from the Spirit article

“The elder care monitoringproject is an excellent concept,”the director of nursing, said.“It is a much better way of

tracking personal hygiene, sleeppatterns and movement.

Our patients, especially in thememory care units, often are notvery verbal, so anything that allowsus to identify potential problems

helps.”

“I can’t sing thepraises of this system

enough,”said the facility director. “The data we gathered

have improved our level ofcare to such a degree that I

won’tlet them take it away.”


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Discussion

Documents

Enabling Technologies for Home Care: Brief Overview and … · 2010. 6. 30. · Home Guardian LLC Copyright 2007, Home Guardian, LLC 4 How did we get here? Recognized impending surge