How do we prevent early complication of chronic diseases, and extra costs related to their treatment?
Первый регион реализации Leningrad Region
Practice description
Tasks:
Improving work quality of doctors in the primary healthcare units
Introduction of remote monitoring of patients’ health is one of the key objectives of the Healthcare national project provided in the Executive Order 204 of the President of the Russian Federation dd. May 7, 2018 On National Goals and Strategic Objectives of the Russian Federation through to 2024, and one of the key stages of modernization of the primary healthcare units presented by the Healthcare Ministry of the Russian Federation to President of the Russian Federation, Vladimir Putin.
Remote monitoring is a digital clinical technology able to transform monitoring of patients with chronic non-infectious diseases.
It dramatically changes the doctor-patient interaction scheme. Instead of patients deciding on their own when they should go to see a doctor, now healthcare professionals make a timely decision based on objective digital data, on how soon and in which way they should contact the patient. That is the main tool for preventing flare-ups and complications.
Stages of implementation in Russian regions:
1. Designing payment for that kind of healthcare out of the CMI funds in the context of regional programs (calculating the tariff, assigning the required healthcare facilities), or from other sources;
2. Signing contracts on equipment supplies with regional healthcare institutions (free use conditions);
3. Training responsible persons and healthcare professionals in remote monitoring methods and technologies.
Project operation procedure:
The attending physician from a healthcare institution (responsible health assessor) prescribes remote monitoring of a patient’s health, including the program and the procedure therefor, after a personal assignment (examination, consultation) and diagnosis confirmation. The attending physician contacts the patient (including remotely, to correct the treatment plan) if there’s a clinical needs to do so.
The patient is provided with a personal telemedicine device (a registered mobile device: a BPM with remote data transmission function, and a GSM module). The patient uses it like a common BPM, with no extra actions. The device transmits the BP data on its own, through the GSM module. The healthcare service provider supplies these monitors to healthcare organizations.
The provider of the remote monitoring service (including the Remote monitoring center) ensures: automated collection and documentation of all cases of patient’s health data transmission and reception by mobile devices, remote diagnostics results (storage, real time 24/7 processing), generating functional diagnosis and providing it to the attending physician in cases where a patient had to get medical help (including ambulance services), emergency response (contacting the patient 24/7) when the patient’s health indicators deviate critically from the threshold values, control of the patient’s adherence to the monitoring program recommended by the attending physician, medical and technical support for doctors and patients 24/7, providing doctors and patients with access to the medical information system around the clock via web interface.
National Medical Research Centers of the Russian Healthcare Ministry (the National Medical Research Center of therapeutics and prevention, supported, if necessary, by senior consulting cardiologists of the Healthcare Ministry) provide methodology support for all the involved parties at launch, including: statistical data analysis to evaluate clinical efficiency, efficiency indicators control, participation in video case conferences in situations where an expert opinion/diagnosis is needed for particularly difficult cases in patients with comorbidities or treatment-resistant.
Implementation experience:
since 2015, including as a Healthnet National Technological Initiative project, in over 40 Russian regions;
report on socio-economic effect of the method employed by specialized Healthcare Ministry National clinical centers, based on practical implementation of the project in 22 Russian regions, involving 106 doctors from 32 healthcare institutions;
over 30 Russian regions (Leningrad, Belgorod, Sakhalin, Kurgan Regions, Altai Territory, etc.)
Practice website
Practice result
In the period from October 1, 2015 to November 1, 2018. together with the Federal State Budgetary Institution National Medical Research Center of Cardiology of the Ministry of Health of the Russian Federation, the Federal State Budgetary Institution National Medical Research Center for Preventive Medicine of the Ministry of Health of the Russian Federation with the participation of the Federal State Budgetary Institution Center for Expertise and Quality Control of Medical Care of the Ministry of Health of the Russian Federation, a study was conducted on the use of remote technologies in dispensary monitoring of patients with chronic non‑communicable diseases on the example of monitoring patients with hypertension, which included 1332 patients from 22 subjects of Russia (presented in the Geographical reference section), with the participation of 106 doctors from 32 primary healthcare medical organizations.
The results of this study (a detailed medical and economic conclusion is presented in the documents of the Ministry of Health of the Russian Federation in the Materials section) they have shown that the introduction of remote monitoring of patients with hypertension allows:
saving more than 90 thousand people in the country annually (about 10% of all deaths from cardiovascular diseases),
providing direct budget savings of funds allocated for emergency medical care, hospitalization and treatment in a hospital, more than 70 billion rubles annually,
at the same time, the efficiency / cost ratio (for remote monitoring) is up to 400%.
With mass implementation of the methodology, the technology provides (forecast values):
250% increased coverage of patients at high risk of complications, subject to continuous medical supervision;
40% reduction in the number of hospitalizations (cases of heart attacks and strokes) due to exacerbations of hypertension;
- reduction in mortality rates from CVD up to 90 thousand people per year in the Russian Federation (about 10% of those who died from CVD), including the working-age population is a 30-50% contribution to achieving the target of the national project to reduce mortality from BSK;
up to 10% reduction in direct budget expenditures in the CMI system due to a reduction in the number of hospitalizations and EMS calls — up to 80% benefit/cost ratio for monitoring;
elimination of personnel shortage in the medical industry and up to 30% release of time of attending physicians when writing prescriptions without face-to-face examination;
as well as: contribution to the indicator of national goals to increase life expectancy, the growth of the indicator of the timeliness of the provision of medical care, the increase in the satisfaction of the population with the quality of the provision of medical care
Implementation cost: From 1 million to 10 million ₽
Implementation stages
2 month
Подготовительный этап
The stages of work are represented as a separate block.