Methodology - e-Health Conference

Report
Mental Health Engagement Network (MHEN):
Connecting clients with their health team
Jeff Reiss MD, MSc, FRCPC
City-wide Site Chief, Mental Healthcare Program – LHSC; Vice Chair, Dept. of Psychiatry – UWO;
Associated Scientist - Lawson Health Research Institute
Nick Zamora
BscPhm, MBA, CHE
Chief Clinical Advisor TELUS Health
Mental Health Engagement Network
Canadian Innovation through Partnerships
o Canada Health Infoway: Consumer Health Innovation Program
o Lawson Research Institute: Comprehensive evaluation expertise
around innovative technologies
o LHSC and SJHC: Pushing transformation
o TELUS Health: Investment in consumer health engagement solution
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The Health and Care Challenge
o 20% of Canadians experience mental illness, only 1/3 receive treatment
o 500,000 employed Canadians are unable to work due to mental illness in
any given week (2/3 disability cases + 1/3 FT absenteeism)
o Mental health is the number one cause of disability in Canada, accounting
for nearly 30% of disability claims and 70% of the total costs
o Current treatment cost estimates of mental illness:
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depression: $5 billion
schizophrenia: $2.7 billion
uninsured mental health services: $6.3 billion
$51B in lost productivity and healthcare costs
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Objectives
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o
o
Improve the health outcomes and quality of life for people living with
schizophrenia or mood disorders
Put novel technology in the hands of clients and their clinical team
Deploy and evaluate customized PHR application that leverages TELUS
health space®, powered by Microsoft Healthvault® , and provides:
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Patient access to their own health information (through LIDB)
Interactive tools such as a mood monitor and journaling
Standardized health services
Ongoing monitoring of activities with alerts and reminders
Regular communication between clients and their care team
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Project Design
o 400 research participants recruited who have been diagnosed with a
mood disorder or a psychotic disorder
o 54 care providers recruited to provide client care using new technology
o Participants recruited through staff caseloads who have volunteered at
outpatient programs in London and surrounding areas including:
• London Health Sciences Centre and St. Joseph’s Health Care
• Community agencies such as the Canadian Mental Health Association
(London Middlesex Branch) and WOTCH Community Mental Health Services
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Mobile Patient Interface is connected
Jurisdictional, regional
& local administrators
• Web access
Clients
• 400 clients
provided with
smartphones
AND access their
Smart record
Family & Other
Supporters
• Access via web or mobile
on own device (no devices
provided by project)
Mental Health Clinicians &
Community Care Providers
• 55 devices will be provided to community
care providers by project
• Remaining care providers will access using
web and/or mobile from own device
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Mobile View
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Provider Portal
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Faculty/Presenter Disclosure
• Faculty: Jeff Reiss
• Relationships with commercial interests:
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Grants/Research Support: Canada Health Infoway and TELUS Health
Speakers Bureau/Honoraria: none
Consulting Fees: none
Other: none
Project Design
o Delayed implementation approach
o Participants were randomized into Group 1 (early intervention)
or Group 2 (later intervention)
o Participants are provided with a handheld device, a TELUS
Health Space account, and a Lawson SMART record timed
according to their intervention group and receive training on
the handheld device and Lawson SMART record
Project Design (Cont.)
o Participants will complete a total of 4 interviews, every 6 months for a
total of 18 months
o Focus groups take place at multiple points in time during the study
o Data collected includes use of devices, perception of usefulness, quality
of life, empowerment, general health, and use of health and social
services (including hospitalizations and emergency room visits as well as
other services)
Expected Outcomes
o The overall hypothesis is that the usage of smart health information
technology will improve quality of life and reduce health care system
costs by providing:
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care providers can closely monitor the individuals recovery process
real-time communication with their care provider team
scheduling appointments and request medication refills
track clients in regards to medication adherence and adverse
reactions
• provide earlier intervention before a crisis situation arises
• provide continued support between formal face to face clinical visits
o To confirm this hypothesis we will use a standardized evaluation
framework that will provide project outcomes on the basis of
effectiveness, economic, policy, and ethical analyses
Mental Health Engagement Network – PROJECT TIMELINE
2011
a
u
g
2012
m
a
r
2013
2014
2015
Design
Phase 1 Dev
Care Providers Wireless 18 mths I-Pads
Phase 1 – First 200 Clients
Design
Phase 2 Dev
Phase 2 – Next 200 Clients
Implementation Into Care.....
Descriptive statistics
n = 400
Age
Mean
Std. Deviation
38.5
13.8
Frequency Percent
Female 155
38.7
Minimum
Maximum
18
78
Male
Total
Sex
245
400
61.3
100.0
Descriptive statistics
n = 400
Mental Health
Developmental Handicap
Anxiety Disorder
Disorder of
Childhood/Adolescence
Organic
Substance-Related Disorder
Frequency
3
128
20
Percent
.75
32
5
3
55
.75
13.75
Personality Disorder
Psychotic Disorder
Mood Disorder
Other
Unknown
25
233
237
10
2
6.25
58.25
59.2
2.5
.5
Descriptive statistics
n = 400
Have you ever had a
psychiatric hospitalization?
Frequency Percent
Estimated total number of
psychiatric hospitalizations
Mean
Std. Deviation
7.7
10.8
No
56
14
Yes
343
85.75
Minimum
1
1
.25
Maximum
100
400
100
n = 343
Missing
Total
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How comfortable are you with technology in general?
N = 400
26.3
25
22.8
20.3
20
16
Percent
15
10
5
5
5.8
4
0
Extremely
comfortable
Slightly
comfortable
Comfortable
Mixed
Uncomfortable
Slightly
uncomfortable
Extremely
uncomfortable
Accessing the Lawson SMART record
12000
10000
9567
Hits to Homepage
8000
6000
4000
3237
2000
0
Mobile
Desktop
Lawson SMART record Usage
Reminders , 462
Scheduling, 971
Messaging, 1728
Health Journal,
5654
Health Journal
Notes, 995
Thinking of your personal health record how do you
feel about its ease of use? (n=147)
How do you feel about having your own personal
health record? (n=178)
How do you feel about connecting with your health
care provider using the smart phone? (n=161)
How do you feel about being able to share your health
information with other health care providers? (n=160)
Summary of Focus Groups Feedback
• Benefits / positive changes through the use of the Lawson SMART
record and iPhone
– Care providers more accessible to their clients and vice versa
– Boost clients self esteem
– Clients feel more connected
• Care provider
• Other community supports
– Facilitates self-awareness within clients and promotes self-reflection
• Privacy and confidentiality with regards to the Lawson SMART
record
– No major concerns
• Workflow Impact
– Time savings
– Increased productivity during client meetings
Where do we go from here?
Who, How and Why:
1.
2.
3.
Build on what has been
done in London
Create Governance
Sustainability and Future
Development Committee
Link to programs and
organizations with same
mandate: The Sandbox
Project, CIHR SPOR TRAM
Evaluation , Development & Sustainability
Planning, Funding, Executing
MHEN is a game changer!
Work with System Change
Agents to Scale and Sustain
Business Plan, Evaluation Engage
Private Sector & Other Jurisdictions
Approach to Maintain 400
Clients & Strengthen Solution
Expand to Youth & Link with
Sandbox and TRAM SPOR
Expand: MH Conditions &
Co-Morbidities
Ontario Expansion
& Establish National Sites
National Expansion
Mental Healthcare
System Redesign
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Questions?
Questions for Dr. Jeff Reiss: [email protected]
Questions for Nick Zamora: [email protected]
MHEN: Transforming the System, Transforming Lives
MAIN OBJECTIVES
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Early Intervention: Monitoring patients moods with automation of alerts to contact care
providers: next of kin, substitute decision maker, family doctor, etc., so services are integrated
and coordinated
Care is Proactive and Ongoing: Through TELUS health space, clients will be able to access
health tools to support them in their recovery, and beyond
Person Driven Access to Care Plans: While this project is aimed to manage a difficult illness,
the lessons learned would support future system redesign for the whole population
Medication Management: most sought after information by community agencies. Patients
can leverage their personal health record to inform care providers so better decision-making
This will ensure that the new care provided is based on prior care for continuity of care
Data Integration: To better utilize Provincial Assessment tools like the OCAN survey and RAI,
which is used in hospitals, but not in community mental health Integrated Referral System
Research Data: This project will support the future linkage with other social services, such as
income support information to elevate clients from becoming homeless. Research data will
inform policy-makers
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Methodology
Technology Implementation
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At Phase 1 (first 3 months of project), the 200 participants in Group 1 will be provided
with a PHR through TELUS health space, as well as they will be introduced to smart
phone technology to ready them for deployment of the prompts and reminders
Two months later, they will be provided with a handheld device. A delayed
implementation plan will be used (but will have no effect on the standard of care for
the remaining 200 participants), so the remaining 200 participants in Group 2 will
initially act as a control group, but at Phase 2 (six months later – approximately June
2012) the remaining 200 participants will be introduced to the technology in the same
order (PHR -> Smart Phone)
Group 2 will have the benefit of any enhancements made during Phase 1 of the
project
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Methodology
Specifically, the study participants will receive the following:
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access to TELUS health space
a PHR application account
access to an online thought diary and mood diary both linked to personalized
recovery/relapse prevention plan
access to a voice scale that assesses auditory hallucinations (for patients with
schizophrenia)
access to a medication side-effect monitoring diary, to trigger a review of
medications, as well as alerts to care providers related to prescription renewals
a handheld device and data plan which will facilitate mobile access to the applications
and interactive tools
individualized proactive prompts and cues to help them structure their days (e.g.
reminder to take medication at 8:00 am)
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Methodology
Quantitative Data Collection
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Individual interviews with patient participants will be held at the baseline period and
then every 6 months for 18 months
Data collected will include use of devices, perception of usefulness, quality of life,
general health and use of health and social services (including hospitalizations and
emergency room visits as well as other services)
The knowledge learned through Group 1, over the initial 6 months, will provide
baseline and comparative data to understand the client’s perceptions for designs and
outcome purposes of the technology intervention
Improvements in the technology approaches made during the initial 6 month period
will enhance the tools for Group 2. We are expecting different feedback from groups,
one to guide development and one to improve what is developed
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Methodology
Quantitative Data Collection
The structured interviews will involve the following seven questions:
1.
2.
3.
4.
5.
6.
7.
Demographic Form
Quality of Life – Brief Version (QoL-BV)
Health, Social, Justice Service Use
Medical Outcomes Study 36-item Short Form Health Survey (SF-36)
EQ-5D Health Utilities Index
Community Integration Questionnaire
Perception of Smart Technology Form
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Methodology
Qualitative Data Collection
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Focus groups will take place at multiple points in time during the study
For Group 1, the focus groups will take place:
1) 2-3 months after initial implementation to discuss initial developments, usability
and adoption (focus on the PHR health space solution)
2) within the next 6 months to discuss addition of phones and issues related to
maintenance or loss
3) a final set of meetings 6 months later to discuss the benefits and pitfalls of the
technology to form base recommendations for the next phase of study
Group 1 will have the opportunity to provide input on the initial technology design
framework, supporting user-centred design (UCD) for novel tool development
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Methodology
Qualitative Data Collection
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For Group 2, the focus groups will take place:
1) prior to implementation to understand how they use technology before the new
approach is introduced and starting with the PHR and health space program
2) 2-3 months after initial implementation to discuss initial development, usability and
adoption of phones
3) within the next 6 months to discuss maintenance or loss
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Focus groups with staff/healthcare providers will also be held so that issues can be identified
and addressed quickly
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