Care@Distance - Home Monitoring System for CHF Patients
Conference contribution, 2007
The number of elderly people in the society is increasing, and with that the expected the health care costs. One reason for this is that the probability of contracting a chronic illness increases with age. Congestive heart failure (CHF) is a typical such illness and it affects approximately 2 % of the population in the western world. Most of the patients are over 60 years of age. By using IT-based home care solutions for follow-up, disease management and treatment compliance these costs can potentially be reduced at the same time as the care of the patient can be improved. It is a matter of patient quality as well as reduced costs.
Many CHF patients tend to return to hospitals with acute conditions where they are admitted for care, only to be discharged a couple of days later. This results in considerable costs for the health care sector, and suffering and insecurity for the patient. Studies have shown that using tele-care, or eHealth, symptoms can be discovered earlier than with traditional care. There is also a better possibility to study and improve patient treatment compliance. Within Care@Distance the intention is to develop a system that can support in acute situations as well as in the long term disease management. Regular daily measurements of physiological data, such as body weight and blood pressure will be done, together with questionnaires where the patients describe their actual medical situation. The combined objective and subjective information can then form a foundation for improving the care of the individual patient. In this project the type of physiological data to be collected and the questionnaire have been defined in collaboration with the DAGA-clinic at Östra Hospital, and Institute of Health and Care Sciences at Sahlgrenska Academy, both situated in Gothenburg, Sweden.
The system is build up of two parts. One is the home client and the other the system server consisting of a web portal for medical personnel together with a central database. The home client is currently a portable Tablet PC combined with a scale and a blood pressure monitor. The computer program is designed to assist the patient carrying out the different measurements and questionnaires. The results are initially stored on a local database in the home client. Measurements will be made of body weight and blood pressure and questions of the current health status of the patient will be asked. These surveys will typically be performed one or several times a day depending on the patient's health status. When the measurement session is over the local database is synchronized with a central database. Measured data and results are sent to the central database, and the home client checks for updates, new configurations, etc. Health care personnel access the information on the central database when needed through the web portal. Besides examining the patient's physiological data and questionnaire results the personnel can also administrate the home client i.e. define measurements, measurement intervals, questionnaire forms etc.
Currently a first generation of the system is out on trial on healthy volunteers in order to verify the functionality of the system. So far the results are promising, and have also led to a number of improvements of both the home client and the web portal. The first clinical trial will begin in the spring of 2007 where a small trial group, identified by the DAGA-clinic, will participate. The focus of this trial is to establish and evaluate interdisciplinary work procedures and technical infrastructure. Following this the system will be stepwise developed regarding measurements and increased functionality.
Of special interest in the future of this project is to develop and verify sensors based on the use of Electric Bio Impedance (EBI). This technique allows for a robust, cheap and relatively simple way to acquire physiological information of large clinical value in relation to CHF treatment e.g. heart function and fluid balance. The ambition is to develop and verify different designs of this kind of sensors, suitable for the home care environment, where user-friendliness is one important factor.