September 25, 2023
I was lucky enough to attend the Wild Health Summit in Sydney recently. Thank you, Jeremy, and Michelle, for hosting such a great panel of experts across a range of relevant digital health topics including one on value-based care. There was a great presentation from Cathy La Riviere showing how McKay Hospital has grown the use of Telecare to handle outpatient appointments. This has had a material impact on the capacity of the hospital and its staff.
This got me thinking about how investing to grow remote patient monitoring (RPM) in NZ can measurably improve capacity for our hospitals. In New Zealand RPM is still in its infancy. Growing it requires that we not only show the value it provides patients but the value it provides hospitals and hospital staff as well.
If our health system is going to invest its limited health budget in RPM, then it needs to invest it in a way that, for want of a better term, delivers the best bang for buck when it comes to reducing health costs. While lots of people can benefit from remote monitoring; remote monitoring lots of people won’t necessarily reduce health costs.
For example, the use of hospital staff to over-service patients that are unlikely to present at hospital will, in fact, increase pressure on hospitals, not alleviate it. If you want to maximise the value of RPM for hospitals, then you need a more targeted approach. Start by identifying patient cohorts where RPM can make the biggest difference to hospital occupancy and flow.
There is an element of forecasting/prediction required to identify these cohorts, but we can be quite confident if we analyse the data. For example, we know from studies that some patient cohorts discharged from hospital are more likely to be readmitted within 30 days than other patient cohorts. We know this from data analysis that determines the statistical likelihood of readmission based on things like age, ethnicity, co-morbities and principal diagnosis.
This study, for example, used “data on hospitalisation and mortality in New Zealand [that] was obtained from the Ministry of Health”. It shows that “medical readmissions are common in older people with 16.1% (95%CI 15.8-6.3%) of admissions resulting in a readmission within 30 days of discharge. The risk of readmission was greater in Maori, Pacific people, men, and people living in deprived areas.
This study found that older “patients of poor health, using 10 medications or more regularly and living in the community with home care, are at greater risk of being readmitted to hospital within 30 days of discharge”. There is a lot of data about 30-day readmission in older adult cohorts and it’s a well-researched area. By targeting RPM to reduce hospital readmissions among a specific cohort like this, we can have a material impact on patient flow at the hospital
This study found that “advanced age was associated with a higher 30-day readmission rate after acute ischemic stroke.
“Appropriate selection of patients for RPM is crucial if a change in acute care use is to be achieved. RPM interventions are likely to have more pronounced effects on acute care use when they are targeted towards populations with a high risk of hospitalisation (e.g., moderate-severe disease severity, multiple comorbidities).”
Reducing (re)admission rates is not the only way RPM can alleviate pressure on hospitals. RPM can also help patients to avoid ED in the first place with remote consultation. They can also be discharged faster when clinicians know that RPM is in place at home. This improves patient flow and directly tackles the growing issue of “bed block” linked to our aging population.
You don’t need to research huge amounts of data to know that unprecedented numbers of older people with long-term conditions will, over the next 20+ years, repeatedly present to NZ hospitals that will struggle to accommodate them. This is a major concern, not just for older people, but for anyone needing a hospital.
Today’s hospitals must create a remote care pathway so that tomorrow’s hospitals have a service to which they can safely refer large numbers of older people with long-term conditions. We need a safe and scalable solution that can concurrently manage the care of thousands of older people at home, thereby reducing their presence in hospitals.
This is what Spritely is actively (and successfully) working on in partnership with a range of healthcare providers around New Zealand. Our technology has been co-designed with older people to make home health management possible for them and their providers.