© 2010 Center for Technology and Aging1

Consumer Digital Health:Technology Assessment and Outcomes Measurements

Lynn Redington, DrPH, MBASr. Program DirectorCenter for Technology and Agingtechandaging.org

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

© 2010 Center for Technology and Aging2

Center for Technology and Aging

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

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

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

© 2010 Center for Technology and Aging3

Technology Assessment Factors --CTA’s Selection Criteria for Grant Program Focus Areas-

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

© 2010 Center for Technology and Aging4

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

© 2010 Center for Technology and Aging5

Focus Area Medication Adherence, Remote Patient Monitoring

Population Vets with CHF, hospitalized within past year

Technology Health Buddy using POTS,

Med Adherence Algorithm, weight scale, BP cuff

Outcomes Reduce hospital/ED visits; improve patient activation, QOL &

satisfaction (randomized, controlled trial)

Workforce Relief Patient Self-Support, Care coordinator (RN), MD oversight,

Automated clinician alerts

Readiness VHA: world’s largest telehealth user, rural health = telehealth

Policy

Relevance

VHA mandated to efficiently change from acute care provider to

a chronic care/preventive care provider

Veterans Health Administration (Central CA) --Example CTA Grantee Project--

© 2010 Center for Technology and Aging6

Technology Intervention Outcomes Measures --Examples from CTA Grantees--

Medication

Adherence

Morisky scale, Beliefs about Medicines, Meds possession ratio

Medical service

utilization

# of hospitalizations, ED visits; cost comparisons between usual

care and technology-enabled care

Technology

adoption

Surveys regarding adoption process, points of resistance,

barriers/drivers, clinician satisfaction, organizational readiness

Patient Patient QOL: SF 12, SF 36, Lorig

Patient Activation: PAM, other empowerment surveys

Caregiver

Burden

Zarit scale

Clinical Weight, BP, A1c, other condition-specific indicators

Study Design

Issues

RCT is gold standard

Validity of pre-post & cohort comparisons?

© 2010 Center for Technology and Aging7

Center for Technology and Aging

www.techandaging.org