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The Pathways Program “Bridging your way to better breathing”
Advocate Health Care, Advocate Home Health Services, Cardio-Pulmonary Rehabilitation, and Physicians collaborating to provide positive outcomes for patients with chronic obstructive pulmonary disease.
Connie Polke Advocate Home Health Services
Goals: Decrease Frequency and Duration of
Hospitalizations Improve Patient Outcomes Return Patient to Self Management Improve Patient Satisfaction Improve Physician Satisfaction Provide Necessary Home Health Services Reduce Symptomatic Complaints
Program Activities: The Pathways Newsletter Quarterly Patient Support Groups Respiratory Therapist 1:1 educational sessions Telehealth via Telephonic Assessments and
support Respiratory Therapist ongoing evaluation of
progress and condition Coordination with other care providers to
standardize education Program Coordinator Case Management and
Clinical Interventions
Program Criteria: Physician order Pulmonary Diagnosis Secondary Diagnosis
Shortness of breath Deconditioning Decrease in ADL’s Decreased Functional or Neurological
Capacity FEV1 < 60%
Measures:
Dyspnea as measured using Borg and ADL Scales
Strength and Endurance as measured by the Six Minute Walk
Health Status as measured by SF-36 Health Survey
Number and Length of Hospitalizations
Telehealth Phone Monitoring via TouchPointCare, data collected included:
Weight Shortness of Breath Sputum Production
Color and Amount Oxygen
Change in Liter Flow Hospitalization
Number of Days Medication
Why We Chose Phone Monitoring:
Focus on the data to be collected, not on methodology
Choose easiest method patients Patients like real voice connection Much cheaper than other telehealth
approaches
Quality of Life Scale
Results of SF-36
0 10 20 30 40 50 60 70 80
Physical Function
Body Pain
Vitality
Role/Emotional
Reported Health Trans
End
Baseline
Results of Six Minute Walk Results of Perceived Exertion and Dyspnea
Six Minute Walk- Distance
1632
1712
Distance
Baseline
End
Rate of Perceived Exertion and Dyspnea
11.2
2.3
10.3
2
RPE RPD
Baseline
End
Weight Change
The Pathways Program Weights
0
50
100
150
200
250
300
Patients
Po
un
ds
Weight Pre
Weight - 3 month
Number of Days Hospitalized
Total Number of Days Hospitalized
79
54
Baseline
End
Data Interpretation
One year data indicative of improvement in the majority of measures
Increase the number of patients in program and continue ongoing assessment
Interpretation of data indicates need for increase in communication and education regarding program goals
Technology Issues for Web Based Phone Monitoring Telehealth:
Hosting eliminates IT hassles
Available 24/7 Secure Server Robust security Daily back-ups HIPAA compliant Easy to interface
Project Summary: Telehealth via TouchPointCare phone
monitoring facilitates patient data collection
RN not needed for data collection, (only assessment of data)
Improved productivity Improved patient outcomes Phone monitoring a cost effective
solution
Contact: Advocate Healthcare:
Connie Polke [email protected] 630-368-6581
TouchPointCare: David Anderson [email protected] 866-713-6590
