City residents need certain essential services for their health, happiness and prosperity. At Smart Cities Council we call those services Responsibilities, since the city has a responsibility to ensure that residents have access. Perhaps one of the greatest challenges in that regard is providing healthcare to underserved and hard-to-serve populations in dense, low-income urban areas. This story offers hope that conventional approaches to healthcare delivery can change in ways that benefit patients, providers and those paying the bill.
By Liz Enbysk / Smart Cities Council
In Brazil, Santa Marta is known as a favela – elsewhere in the world it might be called a shanty town or slum. The impoverished community of 8,000 juts up a steep hill in central Rio de Janeiro, making it particularly difficult for the elderly or disabled who live there to seek medical services.
So Santa Marta was an ideal community for the New Cities Foundation's (NCF) Urban E-Health Project -- an 18-month trial that sent nurses up its steep streets to make home visits to 100 elderly patients suffering from chronic diseases and mobility challenges.
The workers were equipped with backpacks that contained common medical devices – stethoscopes and thermometers, for instance – as well as high-tech medical monitoring equipment developed by GE, a founding member of the NCF (and a Smart Cities Council Lead Partner). According to NCF, the equipment in the backpack enabled the nurses to detect an average of 20 different diseases such as hypertension and diabetes within minutes. One example: The medical workers could take a blood test in the patient's home and have results in three minutes – a process that can take two weeks otherwise. Because of that, both the patients and healthcare providers indicated high levels of satisfaction with the use of the e-health backpack during the home visits, according to NCF.
What else the study found: Regular monitoring of basic health indicators among elderly patients as well as timely diagnosis of chronic diseases generally decreased the risk of hospitalization for patients with certain chronic conditions. In turn, avoiding hospitalization results in substantial savings for the public healthcare system. That benefit is particularly pronounced in the case of elderly patients, whose recovery is slower, more complex and costlier than for the rest of the population and who therefore require lengthier hospital stays.
According to NCF Founder and Chairman John Rossant, "Regular health monitoring programs that incorporate e-health can lead to a significantly lower prevalence of certain clinical conditions -- in particular, strokes, heart failure and kidney dysfunction. For example, for patients in the control group, there was a 14.8% prevalence of hypertension complications, compared to 0.82% for patients in the e-health pilot."
Of course, the high-tech backpacks aren't cheap; each one costs USD $42,000. However, consider the cost savings NCF logged at the trial's conclusion earlier this year:
- The amount of cost savings due to avoided clinical events for specific types of chronic disease ranged between USD $4,000 (heart failure) and USD $200,000 (kidney dysfunction) per 100 elderly patients in the e-health program.
- The cost savings due to avoided hospitalizations of patients with cardiovascular diseases was around USD $136,000 per 1000 patients in the e-health program.
The NCF pilot was conducted in partnership with the City of Rio, and GE. The Department of Clinical Medicine at the State University of Rio de Janeiro collected the data and conducted the analysis for the study. The pilot was further supported by NCF founding member Cisco (also a Smart Cities Council Lead Partner).