1 © 2010 Center for Technology and Aging

Consumer Digital Health: Technology Assessment and Outcomes Measurements Lynn Redington, DrPH, MBA

Sr. Program Director Center for Technology and Aging techandaging.org

vital: the consumer digital health event San Francisco, 6 October 2010

Center for Technology and Aging

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Established in 2009 with funding from The SCAN Foundation, located at the Public Health Institute

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Accelerate diffusion of proven technologies (ADOPT) that help older adults remain healthy and independent

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CTA initiatives

 Technology Diffusion Grants Program  Independent, non-profit resource —research briefs, advocacy, tools and lessons learned (ADOPT toolkit) 

Older adults: A large, growing population with high medical and social service needs

2 © 2010 Center for Technology and Aging

Technology Assessment Factors

- CTA’s Selection Criteria for Grant Program Focus Areas-

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Population Applicability

 Large, growing, high-need, high-burden population segments

Health Outcomes

 Control existing health conditions, prevent exacerbations/adverse events

Economic Outcomes

 Health service use —reduce use per patient, or increase overall efficiency

Caregiver/Workforce Relief

 “Downshifting”--from high-acuity/skilled to low acuity/unskilled care

Technology Viability

 Rogers DoI Theory: Relative advantage, compatibility, complexity, etc .

Stakeholder Readiness

 Ready or resistant? Note: technology viability/stakeholder readiness tradeoff

Policy Relevance

 “Authority-driven” adoption: QI/Cost Savings Initiatives, Subsidies 3 © 2010 Center for Technology and Aging

Promising Technology Focus Areas

- Focus of CTA’s first 3 Grant Programs--

1. Medication Optimization Technologies    Medication adherence Medication reconciliation Medication monitoring 2. Remote Patient Monitoring Technologies   Chronic disease monitoring Safety, falls monitoring 3. Technologies for Post-Acute Care Transitions/Readmissions 4 © 2010 Center for Technology and Aging

Veterans Health Administration (Central CA)

--Example CTA Grantee Project- Focus Area Medication Adherence, Remote Patient Monitoring Population Policy Relevance Vets with CHF, hospitalized within past year Technology Outcomes Workforce Relief Readiness Health Buddy using POTS, Med Adherence Algorithm, weight scale, BP cuff Reduce hospital/ED visits; improve patient activation, QOL & satisfaction (randomized, controlled trial) Patient Self-Support, Care coordinator (RN), MD oversight, Automated clinician alerts VHA: world’s largest telehealth user, rural health = telehealth VHA mandated to efficiently change from acute care provider to a chronic care/preventive care provider

5 © 2010 Center for Technology and Aging

Technology Intervention Outcomes Measures --

Examples from CTA Grantees- Medication Adherence Medical service utilization Technology adoption Patient Caregiver Burden Clinical Morisky scale, Beliefs about Medicines, Meds possession ratio # of hospitalizations, ED visits; cost comparisons between usual care and technology-enabled care Surveys regarding adoption process, points of resistance, barriers/drivers, clinician satisfaction, organizational readiness Patient QOL: SF 12, SF 36, Lorig Patient Activation: PAM, other empowerment surveys Zarit scale Weight, BP, A1c, other condition-specific indicators Study Design Issues RCT is gold standard Validity of pre-post & cohort comparisons?

6 © 2010 Center for Technology and Aging

Center for Technology and Aging

www.techandaging.org

7 © 2010 Center for Technology and Aging