Dr. Nayan Kalnad, CEO of Avegen, writes about how technology is key to improving quality of care and solving current healthcare challenges, especially around cardiac rehabilitation.
A patient of mine was diagnosed with Smoker’s leg and had a difficult to treat wound on his foot. His chronic smoking made the blood vessels in his leg narrow - preventing blood flow, delaying wound healing. For a labourer like him, it was the worst nightmare.
We discussed his options - a skin graft or, amputation, since the wound seemed too severe for other treatment approaches like anti-clotting drugs, to be effective.
There was a catch however. The skin graft would be futile if he started smoking again, since stopping completely is an essential step in such cases. We scheduled a skin graft based on his assurance he will stop completely. But as luck would have it, he ended up needing to have an amputation anyway.
For the clinician in me, the systemic inadequacies to provide continuity and conscious care management, out of hospital, hit home. My patient needed active support to not smoke again and avoid amputation, and it was truly numbing to think how his outcome may have been different, had his relapse been avoided.
The care gap
There are 15 million individuals in the UK alone who could benefit from quality, continued, out-of-hospital care.
The outcome for such cases, rests not on the hospital experience alone, but on the out-of-hospital supportive care needed to control ongoing symptoms through diet, stress management, abstention, prescription drugs, psychosocial counselling etc. To put this in perspective, such patients spend only 0.001% of their time with healthcare providers, while all other health care activities are led by individuals or patients and their families as self‐care activities outside of the clinical or hospital setting.
So, where do we stand today? In cardiac rehab, for example, only one in two eligible UK patients are able to receive rehab benefits, and of those that do, many are not referred timely, do not complete rehab and/or face undue duress with long wait times and wide variations in care delivery.
The clarion call for individualised, evidence-based care pathways is therefore loud, clear and reverberating – across therapy areas.
As patient populations get older, and their needs more complex and intertwined, the trend towards a growing proportion of high-needs patients is only going to widen the gap.
Thankfully today, we have the technology to address this.
Individualised, out-of-hospital care IS the future
Systemic tools to increase patient uptake and engagement, reduce admin burden on hospitals and improve outcomes, are available to impact these patient-centred, personalised care journeys.
Addressing lifestyle management and modification needs post-discharge - with content sharing for knowledge, and gamification for behaviour change - empowers patients, to be able to self-care. Technology today, makes it possible to digitally ‘nudge’ behavioural adherence needed to maintain physical and emotional stability. It enables chronic patients to ‘body listen’ i.e. observe themselves for changes in signs and symptoms – and share distress signals with providers in real-time.
Critical challenges in OOH care
For CVD (cardiovascular diseases) afflicted patients alone, the stats are alarming. A third of worldwide deaths are attributed to CVDs, which also costs the national exchequer £7.4 billion - over four times, the government’s recent NHS pledge.
While servicing the rehab needs for CVD patients will reduce readmissions, improve quality of life and increase life expectancies - the current - episodic, activity-based model of payment falls short and puts incentives in the wrong place.
What remains to be seen is how the system reorients itself to deliver on the ‘value-agenda’ and emerging patient-outcomes based funding models, in out-of-hospital specialist care delivery.
Pilots and initiatives are needed for the unique challenges in the varied therapy situations that out-of-hospital care may address, ranging from end-of-life care, unconscious or comatose patients to emergency care and/or stable patient management etc.
Health and social care funding streams will need to be aligned, risks and information sharing around both finance and quality addressed, and last but not the least – a common vision of what constitutes ‘good or better’ outcomes across OOH therapy areas will need to be agreed upon.
Requirements for good OOH care
There is no longer any doubt about what is needed for good quality OOH care though.
For providers, having a global view of the patients under their care and the ability to focus their efforts on the ones that need more support, is paramount. Being able to communicate efficiently with their patients and other care providers, for optimal use of resources in real-time also underpins good OOH systems.
For Patients - convenient access to the care provider and effortless tracking and sharing of key health and lifestyle parameters are crucial enablers. OOH systemic tools should help them learn about their condition, how to best manage it and how to flag up concerns.
At a time when healthcare funding trends are prosaic, but demographic pressures are on the upswing, effective out-of-hospital care is vital to ease the burden on in-hospital care systems. Those healthcare providers who can successfully offer quality care in OOH settings and master the value agenda while they’re at it, will not only be rewarded with sustainability but also with what may truly matter in healthcare tomorrow – excellence in patient outcomes and value beyond the walls of the clinic.
