THE NEXT-GENERATION HOUSE CALL
By Ray Dorsey, MD | Mar 2, 2018 | This post was created for Rock Health’s Impact Project
In an effort to facilitate impact-first healthcare innovation, Rock Health, the first venture fund for digital health, has launched the Impact Project. The ongoing project shares stories of how patients across the United States have been affected by tech-enabled healthcare solutions and encourages innovators to prioritize the patient experience above all.
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Our current system of care is fundamentally flawed. We ask patients with limited mobility, driving ability, or cognitive ability to come see us healthy physicians on our terms; instead, we should see them on theirs. This flaw prevents many from accessing care; for example, 40% of individuals over 65 with Parkinson’s disease don’t see a neurologist for their condition, and those that don’t are more likely to fracture a hip, be placed in a skilled nursing facility, and die.1
A decade ago, we began by providing telemedicine to individuals with Parkinson’s disease in nursing homes. These patients had previously been making multiple, long-distance trips a year to receive neurologist care, but after a trial of telemedicine, we found that those patients experienced significant improvements in their quality of life and motor function, as well as higher satisfaction with their care. Building on that success, over the last six to seven years, we’ve extended our reach to providing care to people directly in their homes. With the generous support of the Patient- Centered Outcomes Research Institute and support from the National Parkinson Foundation, we conducted the first national, randomized controlled trial of telemedicine.2
Nearly 1000 people across the US expressed interest in participation, and 200 were enrolled, randomized to receive either regular care in their community, or regular care in their community plus an additional four virtual visits with a Parkinson’s disease specialist. University of Rochester specialists provided care at 18 sites around the country including Duke, University of Pennsylvania, UCSF, and Johns Hopkins. We demonstrated that telemedicine was feasible, generated comparable clinical outcomes to regular care, and saved patients on average about three hours of time and 100 miles of travel per visit. We recorded immense satisfaction, with over 85% of physicians and 97% of patients satisfied or very satisfied with the care provided and received. In fact, at the end of the study, patients preferred virtual visits with the remote clinicians they have never met before to seeing their local clinicians whom they had rated highly.
Based on those results and generous support from the Safra foundation and the Greater Rochester Health Foundation, last year we launched Parkinson Disease Care New York. For the first time, anyone with a given condition (Parkinson’s disease) in a given geography (New York), can receive specialist care regardless of who they are, where they live, or their ability to pay. For nearly 200 people with Parkinson’s disease (and more to come) in this statewide program, we’re providing care in their homes, for free, for at least a year. We’ve worked hard to address individuals who might be on the other end of the health divide; those who are older, less educated, and those who live in rural communities. Through extensive in-person and social media outreach across greater New York, we’re now reaching patients as old as 91 who primarily live in areas with a shortage of health professionals, 20% of whom are homebound and 60% of whom have less than a bachelor’s degree.
We’ve found success in our in-person outreach efforts through regular visits to Parkinson and Huntingdon disease support groups, community centers, religious organizations, primary care offices, and county aging offices. Our online outreach through Facebook has also yielded extraordinary results. We push our content to individuals based on pages they have liked (Parkinson Foundation, Michael J Fox Foundation, etc.), based on their location, and a number of other factors that help us show our content to the people most likely to benefit. Major advocacy organizations have also shared our content to help spread the word.
We’re training allied health professionals (speech, occupational, and physical therapists) through a collaboration with ParksinsonNet in the Netherlands. We’re organizing leaders in technology, health, and policy to develop innovative solution for aging Americans at our annual d.health summit. We’ve also produced ParkinsonTV, a series of online educational episodes that patients and caregivers can watch to learn about exercise, nutrition, and advanced therapies for Parkinson’s disease. These episodes have reached nearly 100,000 individuals with over 10,000 views in 65 countries with over 100,000 minutes cumulatively watched.
Beyond Parkinson’s disease, this model could be used to deliver care for chronic conditions, including Alzheimer’s, autism, and heart disease, nationally and internationally! All these efforts are aimed at a solution to the fundamental challenge in modern medicine; ensuring that anyone, anywhere, can access care.
To see the ongoing project profiling individuals who have been impacted by tech-enabled healthcare innovation, visit impact.rockhealth.com.
For additional references regarding the state of telemedicine in the United States, please visit http://annals.org/aim/article/2275392/return-house-call and http://www.nejm.org/doi/full/10.1056/NEJMra1601705
- Willis, A. Neurologist care in Parkinson disease: a utilization, outcomes, and survival study. Neurology, 2011;77(9):851-857.
- Connect.Parkinson Investigators. National randomized controlled trial of virtual house calls for Parkinson disease. Neurology, 2017;89(77):1152-1161.