Maccabi proactive Telecare Center for chronic conditions – the care of frail elderly patients

Abstract

BackgroundIn 2012, Maccabi Healthcare Services founded Maccabi Telecare Center (MTC), a multi-disciplinary healthcare service providing telemedical care to complex chronic patients. The current paper describes the establishment and operation of the MTC center, from the identification of the need for the service, through the design of its solution elements, to outcomes in several areas of care.We analyze the effects of the program on elderly frail patients, a growing population with complex and costly needs.MethodsObservational quasi-experimental analyses using propensity score matching was used to assess the effect of MTC’s operation on utilization outcomes including direct costs.ResultsResults for frail elderly patients with complex chronic conditions show significant reductions in hospitalization days and hospitalization costs. MTC interventions also entailed lower overall average monthly costs in frail patients.ConclusionWe conclude that a proactive telehealth service for complex chronic patients using education, empowerment to self-management, and coordination of care is a cost-effective means of improving quality care and health outcomes in frail elderly patients.Electronic supplementary materialThe online version of this article (10.1186/s13584-017-0192-x) contains supplementary material, which is available to authorized users.

Healthcare utilization of breast cancer patients following telephone-based consultations of oncology nurse navigator via telemedical care

“…This trend is similar to that observed by Beaver et al [27], who found that compared to hospital-based consultations, nurse-led telephone follow-up resulted in more referrals to specialists (such as hospital, doctor, or clinical psychologist) during routine follow-up and 27% higher costs in treating recurrent breast cancer [27]. However, results from the study of Porath et al, in the same setting as ours (TMC in MHS), revealed a significant reduction in hospitalizations for frail chronic elderly patients who had received this service [25]. This difference may stem from the different nature of HCU of chronically ill patients and those with breast cancer, and the corresponding role of TMC in these two populations.…”

“…ONN-led telephone follow-up is provided through this platform as well. Recent research in MHS revealed that TMC services for elderly patients that provide proactive empowerment for self-management can improve the quality of care and is also cost-effective [25]. TMC is especially suitable for frail, home-bound patients with complicated medical conditions [25, 26], and for patients in rural areas where fewer health centers are available [22, 25].…”

“…Recent research in MHS revealed that TMC services for elderly patients that provide proactive empowerment for self-management can improve the quality of care and is also cost-effective [25]. TMC is especially suitable for frail, home-bound patients with complicated medical conditions [25, 26], and for patients in rural areas where fewer health centers are available [22, 25]. Modern technologies can be used to safely and effectively follow up as an alternative to traditional models that require patients to travel to tertiary cancer centers for face-to-face visits [24].…”

Personalized Health Systems—Past, Present, and Future of Research Development and Implementation in Real-Life Environment

“…HbA1C levels remained stable, indicating that training and patient engagement produce long-term outcomes. In frail patients, the 389 frail patients treated during 2015 showed a 30% reduction in hospitalization days and lower overall average monthly costs compared to control (2). All patient groups showed a significant improvement in health behavior (vaccination, physical activity, and healthy eating), QoL, and mental health.…”

“…These programs were first implemented as pilots that failed to show clear evidence: clinical and economic. Only in places where the implementation moved beyond pilots to the level of services with ongoing assessment, evaluation, and adaptation is there evidence for clinical and cost–benefits (2).…”