Using technology to transform care for patients with Parkinson disease

MATRC Telehealth SummitMarch 18, 2013

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Disclosures

Grant fundingGrant

funding

ConsultingConsulting

StockoptionsStock

options

•Agency for Healthcare Research and Quality•Avid Radiopharmaceuticals•Google•Excellus BlueCross BlueShield•Lundbeck•Macklin Foundation•National Institute for Neurological Disorders and Stroke•Prana Biotechnology•Verizon Foundation

•Avid Radiopharmaceuticals•Clintrex•Lundbeck•Medtronic

•ConsultingMD

PatentsPatents•Pursuing a patent related to receiving care via telemedicine

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Outline

• The burden of Parkinson disease and other chronic conditions is growing, but access to care is limited

• Technology can remove geographic barriers to care

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Outline

• The burden of Parkinson disease and other chronic conditions is growing, but access to care is limited

• Technology can remove geographic barriers to care

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The burden of Parkinson disease and other neurodegenerative conditions is growingDistribution of individuals with Parkinson disease by country from 2005 to 2030*

Source: Neurology 2007;68:384-6

*Among individuals over 50 in the world’s ten most and Western Europe’s five most populous nations

2005100% = 4.1 million individuals

2030100% = 8.7 million individuals

China, 48%

Europe, 14%

China, 57%Others, 12%

Brazil, 4%

U.S. 8%

India, 8%

Europe, 20%

India, 8%

U.S. 7%

Brazil, 4%

Others, 10%

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Access to specialty care and clinical trials is geographically restricted in the US

Sources: Movement Disorders Society directory; wemove.org

*excludes NIH/NINDS, FDA, neurosurgery, and the Washington D.C. area

Distribution of Parkinson disease specialists in Maryland*

In Maryland, 20 of 23 counties do not have access to a Parkinson disease specialist

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Forty percent of Medicare beneficiaries with Parkinson disease have not seen a neurologist

Source: Courtesy of AW Willis 2012

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Access to care is even more restricted around the world

Sources: Movement Disorders Society directory; Neurology 2007;68:384-6; WHO Country Resources for Neurologic Disorders 2004 (WHO, 2004)

• In Bolivia, not one of the individuals identified with Parkinson disease had seen a physician for his or her condition

• In China, there are ~50 Parkinson disease specialists for ~2 million people with the condition

Worldwide, most people with Parkinson disease have likely not been diagnosed and most likely have not been treated

• In 40% of all countries, anti-Parkinsonian drugs are generally not available

• In 83% of low income countries, there are no available treatments for Parkinson disease

Patients who see a specialist have significantly better outcomes and survivalSix-year survival among patients with Parkinson disease

Source: Neurology 2011; 77:851-857

Patients with Parkinson disease who see a neurologist are:• 14% less likely to have a hip fracture• 21% less likely to be placed in a skilled nursing home facility• 22% less likely to die

Patients who see a neurologist

Patients who see a primary care physician

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Excellent specialty care is available and can improve outcomes for a variety of conditions

Specialists lead to higher quality care•Heart disease More appropriate medication use•Asthma Greater adherence to national management guidelines•Diabetes Better process measures

Higher quality care improves outcomes•Heart failure Increased survival

•Asthma Improved quality of life

•Diabetes Fewer complications

Model of improving outcomes

Sources: NEJM 1994;331:1136-42; Arch Int Med 1998;158:457-64; Diabetes Care 2004;27:398-406; CMAJ 2005;172:189-94; J Allergy Clin Immunol 2005;116:1307-13; Mov Disord 2007;22:515-22

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Outline

• The burden of Parkinson disease and other chronic conditions is growing, but access to care is limited

• Technology can remove geographic barriers to care

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We are using simple, inexpensive technology to reach patients around the worldTelemedicine can be used to reach people anywhere

Equipment

•Laptop or portable device•Internet connectivity•Web cam, microphone•Encrypted software

• In-home care•Remote patient monitoring•Remote study participation

Source: Dorsey ER et al. Mov Disord 2010;25:1652-9; Biglan KM, Dorsey ER, et al. Mov Disord 2009;24:1073-1076

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Telemedicine visits are similar to in-person visits in content

We completed a randomized, controlled trial of virtual housecalls for Parkinson disease

20 patients with PD at two centers

11 patients receive 3in-person visits over 6 months

9 patients receive 3 telemedicine visits over 6 months in home

Randomized

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Outcomes:

1. Feasibility 2. Clinical outcomes3. Economic value

Telemedicine

In-person

Sponsors:Source: “Randomized, controlled trial of “virtual housecalls” for Parkinson disease” (2013) JAMA Neurology. In press.

Telemedicine is a feasible means of providing care into people’s homes

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Telemedicine

Perc

ent

In-person

91%

Proportion of visits completed as scheduled

93%

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Patients in both arms had similar clinical outcomes

*Excludes assessments for rigidity and postural stability

Bet

ter

Telemedicine (n=9)

In-person care (n=11)

Change in Quality of LifePoints on PDQ-39 scaleN=20 total

+4.0

+6.4

+1.2

Telemedicine (n=9)

In-person care (n=11)

Bet

ter

+3.9

Change in Motor FunctionPoints on modified UPDRS Part III* scaleN=20 total

+1.2

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Patients in the telemedicine arm rated their quality of care higher

Telemedicine (n=4)

In-person care (n=6)

Bet

ter

Change in Quality of CarePoints on Patients Assessment of Chronic Illness Care (PACIC)N=10 total

Wo

rse

+1.4+1.5

- 3.8

Telemedicine flips the paradigm

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Patient time spent on in-person versus telemedicine visits

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Using telemedicine, we have extended our reach into homes in 5 states…

Our program has saved patients roughly 20,000 miles of travel

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…and 15 countries

Our program has saved patients over 200,000 miles of travel

With support from Verizon, we launched a free telemedicine clinic for patients with PD

Patients selected each month to

participate

Technology specialist assists in

setup

Patients receive care from PD specialist

Recommendations sent back to patients and their physician

Patients call 855.237.7666 to

request an appointment

21Source: www.hopkinsmedicine.org/pdtelemedicine

Supported by:

If you or someone you know live in MD, DE, CA, FL, or NY, and

are interested in receiving a free

consultation:

Call 855-237-7666 to enroll!

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We are just scratching the surface of what is possibleGrowth horizons

Impact

Phase 1Provide care to individuals with Parkinson disease directly in their homes (“virtual house calls”)

Phase 2Increase scale and reach of model nationally and globally

Phase 3Expand scope to other conditions (e.g., Huntington disease, ataxia)

Time

Our vision is to provide patient-centered care to individuals with

Parkinson diseaseanywhere they live

Our vision is to provide patient-centered care to individuals with

Parkinson diseaseanywhere they live

Phase 3Expand scope to other conditions (e.g. Alzheimer’s, Huntington disease, etc.)