Virtual Clinic follow up of hip and knee joint replacement Helen - PowerPoint PPT Presentation

Virtual Clinic follow up of hip and knee joint replacement Helen Williams, Directorate Manager, T&O Nicola Fuller, Surgical Care Practitioner Dan Williams, Hip & Knee Consultant Co-founder, MyClinicalOutcomes @danhwilliams Friday 17 May 2019

Virtual Clinic follow up (vFup) Healthcare Cornish population aged 65-84 Newer, more expensive tests § and treatments An ageing population with more § chronic disease £30 billion p.a. funding gap by § 2020 ê Demand, é Funding or Improve efficiency (2011 Census, 1st Release, July 2012, ONS)

Information revolution.. Digital Health Exponential growth in computer power / £ § Digitisation § Layered innovation §

Cost-effecOve health technology is a recent phenomenon Digital Health 1998 2000 2002 2004 2006 2008 2010 2012 2014 2016 2016 NHS PROMs Apr 09 - Present NPfIT Apr 05 – Mar 2013

Patient Reported Outcome Measures (PROMs) Digital Health 736 hip & knee replacement patients § Validated PROMs § Factors => return to sport 12mths post-op § Ø Age Ø Male sex Ø BMI Ø Pre-op UCLA activity Not operation or implant § Williams DH , Garbuz DS, Masri BA, Greidanus NV, Duncan CP. Predictors of pardcipadon in sport following hip and knee arthroplasty Clinical Orthopaedics and Related Research 2012;470(2):555-61

Disclosure

Disclosure

Virtual Clinic follow up (vFup) Hip (THR) & Knee (TKR) replacement Eng & Wales NJR THR / TKRs : § 160,000 p.a. when started § 208,364 p.a. 2016, ⬆ 3.7% § 1200 THR / TKR p.a. Cornwall § Nadonal (BOA) guidelines <75yr § padent follow up at: § 1yr, 7yr, 10yr + every 3yrs 90-95% doing well at 10 years § ..is there a beXer way? “Primary Total Hip Replacement: A Guide to Good Practice.” British Orthopaedic Association. First published 1999, revised Nov 2012

Virtual Clinic follow up (vFup) Hip (THR) & Knee (TKR) replacement VIDEO “Primary Total Hip Replacement: A Guide to Good Practice.” British Orthopaedic Association. First published 1999, revised Nov 2012

1. Locally taken x-ray film

1. Locally taken x-ray film Royal Cornwall Hospital

2. Web based Oxford hip or knee score Patient-friendly interfaces ensure § comprehensive data collection Understand current condition § between clinical appointments using validated scores Receive personal feedback § tailored to condition, change in score and stage of treatment Track improvement (or § deterioration) over time

2. Web based Oxford hip or knee score PaOent-friendly interfaces ensure § comprehensive data collecdon Understand current condidon § between clinical appointments using validated scores Receive personal feedback § tailored to condidon, change in score and stage of treatment Track improvement (or § deterioradon) over dme

‘Related Information’ via NHS choices.. Patient-Side Rich content improves engagement PaOent and treatment specific content from NHS Choices

Virtual clinic

Virtual clinic Clinician-Side

Virtual clinic Clinician-Side Email report and plan to GP and patient §

Virtual Clinic follow up (vFup) Aim § Swap 2 face-to-face for 5 vFup § Target clinic capacity to those who need it most

..no brainer..?!

An Interlude.. London Underground London growing faster than any other European city; § Population 8.6 million => 10 million by 2030; § London Infrastructure Plan 2050 predicts demand system to rise by 60% § Archie Bland, Guardian 16Jan16

An Interlude.. London Underground “We might be bad at dancing § and expressing our feelings, but say this for the Bri=sh.. when we se@le on a conven=on of public order, we bloody well s=ck to it. We wait in line. We leave the last biscuit.. and when we take the escalator, we stand on the right. The leD is reserved for people in a hurry..” Paul Stoneman and Celia Harrison, TfL strategic planners, at Holborn station Archie Bland, Guardian 16Jan16

An Interlude.. London Underground 31 more passengers could § get on to the escalator each minute; An increase of 28% § => 3 week trial Holborn § Archie Bland, Guardian 16Jan16

An Interlude.. London Underground a “very bad idea” “I know how to use a bloody escalator!” “ terrible ” “ loopy ” “ crap ” “ ridiculous ” ..and in a one-hour session, 18 people called it “ stupid ” Archie Bland, Guardian 16Jan16

An Interlude.. London Underground Result 8.30 and 9.30am § 12,745 customers => 16,220 § Didn’t match theoretical § numbers => it exceeded them.. ..we’re still standing on the right L Archie Bland, Guardian 16Jan16

Virtual Clinic follow up (vFup) Results: 12 months 300 patients followed up; § 520 additional patients choosing the § new service for future follow up; Only 21% of slots filled §

Virtual Clinic follow up (vFup) Results: 12 months High levels of sadsfacdon; padents finding it effecdve § n=72

Virtual Clinic follow up (vFup) Results: 12 months High levels of satisfaction; patients finding it effective, quick § n=72

Virtual Clinic follow up (vFup) Results: 12 months High levels of sadsfacdon; padents finding it effecdve, quick and easy; § “ easy to follow and no concerns” n=72

Virtual Clinic follow up (vFup) Results: 12 months All survey respondents reported § having an x-ray at a location of their choice n=75

Virtual Clinic follow up (vFup) Results: 12 months All survey respondents reported § having an x-ray at a locadon of their choice; 70% saved dme § n=61

Virtual Clinic follow up (vFup) Results: 12 months All survey respondents reported § having an x-ray at a location of their choice; 70% saved time, 79% saved money § n=61

Virtual Clinic follow up (vFup) Results: 12 months interviews 8 purposively selected padent interviews; 2 qualitadve § researchers § based on age, employment status, educadon and sadsfacdon of the virtual clinic experience § using topic cards, recorded, transcribed => simple descripdve themadc analysis 2 consultant surgeons § Google => ‘BMJ Virtual Clinic’ § https://bmjopenquality.bmj.com/content/8/1/e000502

Virtual Clinic follow up (vFup) Results: 12 months interviews Patients who were trouble free § liked the “click and go approach” Time and money: § “Well, it’s probably half to three quarters of an hour each way and then you have got to pay for parking, haven’t you? It’s a chunk of your day, isn’t it?”

Virtual Clinic follow up (vFup) Results: 12 months interviews Self management: § “I found it really interesting because when I first went on it was before the operation so it would have been very low then, just to see it jump right up after the operation, …..”

Virtual Clinic follow up (vFup) Results: 12 months interviews Altruism: satisfaction that the § virtual clinic was freeing up the consultant’s time to see those in need Using technology: most found § straight forward

Virtual Clinic follow up (vFup) Results: 12 months interviews Recognise that people value face- § to-face interaction Clear pathways of communication § are essential

Virtual Clinic follow up (vFup) The challenges Clinician engagement § An operadonal project lead § Our organisadon is a barrier to § innovadon § “We are too busy to improve” § Leadership

Virtual Clinic follow up (vFup) What worked well.. Project administrator § § Single point of contact Pending list § § Track engaged padents Behavioural Insights (BI) workshop § Padent sadsfacdon § § Technology is seen as a route to improve healthcare; elderly group CQUIN + Tariff

Virtual Clinic follow up (vFup) 1127 patients ‘seen’ | 25 patients per month Update: 4 years Band 8 nurse appointed 70 CQUIN £216,000 60 Ongoing £45 tariff agreed 50 Staff moved 40 30 20 10 0 5 5 5 5 6 6 6 6 7 7 7 7 8 8 8 8 9 4 4 5 5 6 6 7 7 8 8 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 - - - - - - - - - - - - - - - - - - - - - - - - - - - t c b r n g t c b r n g t c b r n g t c b r n g t c b c p c p c p c p c e e u e e u e e u e e u e e u u u u O O O O O D A D A D A D A D F J A F J A F J A F J A F

What’s possible..? www.danhwilliams.com

What’s possible..? www.danhwilliams.com

What’s possible..?

What’s possible..?

What’s possible..?

1. Get going! Invest in.. Arthroplasty care practitioner + § admin support Chose tech supplier (ICHOM) § Leaflets + letters (use ours!) § https://www.dropbox.com/home/Virtual%20clinic hXp://techhub.ichom.org

2. Early commissioner involvement National tariff hXps://improvement.nhs.uk/resources/naOonal-tariff/

Thank you Helen Williams, Directorate Manager, T&O Nicola Fuller, Surgical Care Practitioner Dan Williams, Hip & Knee Consultant Co-founder of MyClinicalOutcomes @danhwilliams Friday 17 May 2019