Delivering healthcare via telecommunications could open up home monitoring of aged care patients with chronic diseases, improving health outcomes and significantly saving costs.
Current models of preventing the recurrence of cardiac event has been through cardiac rehabilitation (CR) programs offered through centre-based or outpatient clinics. These models are reported to have lower patient participation rates (14-43% after myocardial infarction) in both Australia and globally.
To increase the level of CR participation, researchers at the Australian e-Health Research Centre (AEHRC) have developed a novel technology based home-based care model for outpatient cardiac rehabilitation by using smart phones, web-services and other information and communication technology (ICT) tools, called the Care Assessment Platform (CAP). To ensure the CAP care model aligns with the a comprehensive model outlined for a CR program, the AEHRC project team together with the Queensland Health clinical team, integrated lifestyle/clinical risk factor modification components of chronic diseases, human factors, health behaviours, information systems, and monitoring technology.
The project is currently in its final stage of testing the CAP care model through a randomized controlled clinical trial (RCT) among 120 eligible CR patients, within the Primary and Community Health Services of Metro North Health Service District of Queensland Health. The objective of the RCT is to provide evidence of clinical and economic outcomes associated of the developed CAP care model and technologies. In addition to innovations in process development and technologies, the trial is expected to create new clinical knowledge on physiological signal patterns, exercise, diet, lifestyle, and behaviour of cardiovascular patients in home care setting.
CAP Care Model for Home- Based Cardiac Rehabilitation
The CAP care model integrated within a comprehensive home-based care model for outpatient CR is shown above in Fig. 2. The patients are using smart mobile phones with a built-in accelerometer to measure their physical exercise at home. A WellnessDiary software (by Nokia Research) on the mobile phone is used to collect physiological data and self observations such as exercise, weight, blood pressure, stress, sleep quality, tobacco and alcohol use. Mobile phones are also used for video- and/or tele- conferencing during weekly coaching sessions with a personal Specialised Mentor aiming at behavioural modifications through goal setting. Additionally, we are developing mobile phone software tools to capture and analyse Heart Rate and movement activity from wearable sensors. The data on the phones is synchronised daily to a web-portal that the Mentors use to facilitate personal goal setting and to assess the progress of each patient in the program. Educational multimedia content and relaxation audio files (by Multi-ed Medical) are stored on the patients phone to be viewed on demand. The patients receive also daily motivational SMS messages which support the education and goal setting.
The AEHRC has expertise on liaising with clinicians and running clinical trials involving ambulatory monitoring and other advanced ICT tools. The CAP team has finalised several clinical trials and projects in conjunction with Queensland Health across various healthcare settings.
The objective of the CAP Phase 1 completed in 2008 was to find useful measures which can be derived from ambulatory monitoring devices measuring movement activity and heart rate. The measures should help in assessing the patients’ functional capacity attending a CR program. A clinical trial was carried out for this purpose on patients (N=17) undergoing stage 2 of CR program in Redcliffe and Caboolture hospitals. The main findings were that the changes observed in 6 Minute Walk Test (6MWT) distances correlate directly with the changes and absolute levels of the measured non-rehab day Energy Expenditure levels expressed in Metabolic Equivalent (MET). The results indicate that the ambulatory measures of MET levels in free living environment can be surrogate measures of 6MWT measurements performed in clinical settings. Borne from this study were development of other set of measures derived from accelerometer signals and ECG in ambulatory setting providing continuous measure of functional capacity. These measures include discrimination of walking from other high intensity activities, calculation of walking speed to determine index of functional capacity, energy expenditure, the amount and duration of walking events that can be used to design personalized interventions, and sit-to-stand transitions to better classifies activities of daily living.
Furthermore, leveraged from current CAP project (outline above), AEHRC have also developed mobile phone applications for Health Promotion targeting the rural/regional community and COPD management. These applications are currently undergoing an efficacy and pilot clinical trial, respectively.