Increased adaptation on many levels:

For a long time, studies have shown that patients living with chronic diseases can experience a process of behavioral, functional, and psycho-social adaptation to their limitations over time. Most people breathe an average of 22,000 times per day. We do not think about breathing often – it would be impossible for us to work on anything else if breathing involved conscious effort. In particular, with asthma and COPD, most people develop sub-conscious adaptations to accommodate for decreased breathing capacity, to the point where they may be insensitive to changes in breathing that may alert them to worsening conditions. 


Asthma – Expensive, No Meaningful Movement in Outcomes:

With 25 million Americans suffering from Asthma, there’s much more that our healthcare system needs to do to help. 

A critical component of optimizing asthma control is the engagement of patients as active participants in their asthma management. Motivated and well-informed patients can assume a great deal of control over their asthma care, but few have even received basic asthma education. In fact, education on asthma self-management (ASME) is part of the CDC’s 6|18 Initiative, targeting six common and costly health conditions with 18 proven interventions., Several studies involving diverse cohorts, including Medicaid and Medicare populations, have shown that patient education decreases hospitalizations, minimizes asthma exacerbations, and improves daily function.,, However, programs requiring frequent, in-person consultations are not scalable and have continuously failed to engage an adequate number of patients to have a broad-based impact.

Health Care Originals’ Nightingale Virtual Respiratory Care Program Description and Outcomes:

Our virtual care platform, Nightingale, is a Virtual Respiratory Care Program that  demonstrates meaningful outcomes from providing patients members with individualized combinations of self-management education, unparalleled insights from ADAMM, dedicated respiratory therapists and wellness coaches.

In addition, Nightingale provides accommodation for SDOH related to health care access for everyone  and a health outcome factors-based program within which Nightingale is implemented. In contrast with traditional, in-person consultations, Nightingale provides convenient at-home patient education with repeated, ongoing check-ins.


Nightingale – the necessary complement to pharmacological therapy

Nightingale as described embodies the tenets established as being necessary beyond pharmacological treatment and includes:

  • Enhanced self-monitoring – patients understand their leading indicator data in more detail through ADAMM.
  • We facilitate daily airway clearance through provision of OPEP devices.
  • Self-management education – tips, education delivered in a variety of ways that are patient-friendly, easy to understand.
  • Respiratory therapists provide clinical insight to patients.
  • Life coaches address some psychosocial issues, helping patients to visualize life goals that drive increased adherence as they are realized.


Nightingale outcomes shown to be clinically efficacious (SGRQ)

One measurement of asthma severity is the St. George’s Respiratory Questionnaire (SGRQ), which measures overall health, daily life, and perceived well-being. We use the St. Georges Respiratory Questionnaire (SGRQ) for mapping progress of our members over time. SGRQ has been shown to be predictive of COPD outcomes. 

SGRQ is a disease-specific instrument designed to measure impact on overall health, daily life, and perceived well-being in patients with obstructive airways disease such as COPD. Scores range from 0 to 100, with higher scores indicating more limitations.

SGRQ is separated into a Symptom score, an Activity score, and an Impact score. The Symptoms component reflects frequency and severity. The activities score reflects how activities cause or are limited by breathlessness. Impact components (social functioning, psychological disturbances resulting from airways disease) reflect well on quality of life.

A clinically significant change for the patient is consistently around 4 units. For context, mepolizumab (a biologic drug approved in 2015 for a certain phenotype of severe, uncontrolled asthma) accounted for an improvement in SGRQ of -5.3 points and -6.2 points in recent clinical trials.

According to the American Thoracic Society, for the SGRQ a mean change of:

  • 4 units is associated with slightly efficacious treatment, 
  • 8 units for moderately efficacious change and 
  • 12 units for very efficacious treatment,

Preliminary data from Nightingale users reveals an improvement in SGRQ of -12 points.

 Nightingale’s SGRQ results show that we are clinically efficacious in limiting impairment.

We focus first on ensuring that patients are aligned with a life goal and see results in 3 months.

The sharp decrease in SGRQ score within the first 3 months is key. Patients understand quickly that Nightingale works for them, which results in sustained adherence and ongoing compliance.

This component is perhaps the major contributor from a psychosocial perspective and is what drives this significant improvement in HRQoL within the first 3 months.

Because patients see results, results are sustained.

Improvement in symptoms is driven by increased adherence. We help patients draw the connection to improved systems because of medication adherence.

Because we encourage regular airway clearance where applicable, medicines are also more effective.

We effectively work against the normal psychological barriers – people may not be able to tell independently when something is working, so they stop, or conversely, they may stop when they feel better, not drawing the connection that they need to continue to comply to feel better.

Nightingale improves sleep quality

We use the COPD and Asthma Sleep Impact Scale (CASIS) to measure sleep quality of our members. CASIS scores show significant positive correlation with the Medical Research Council (MRC) Dyspnoea Scale. The CASIS instruments is valid and useful in understanding the overall impact of COPD on daily life, fatigue, and sleep impairment in patients with moderate to severe COPD.

Once again, the whole health approach of Nightingale ensures our members experience improved sleep, which is another key underpinning to improvement in depression and quality of life perception.

Testimonials from our members

Although the clinical instruments show it, the best testament to our effectiveness are the words of the members themselves. 

“Working with the Nightingale Program has helped me ensure I take my inhaler regularly. I haven’t missed a dose of medication in weeks now which is not something I could have said in the past. I had the interesting opportunity to express my wellness vision through artwork. I breathe easier having participated in the Nightingale Program.” Member with COPD, female, 72 years old

“The Nightingale system has really helped me with clearing my airways – I understand better how to do it and have better results. I like how their Respiratory Therapist engages with me and having them to talk to really helps me to understand my medication and condition better.” Member with COPD, Male, 80 years old

“The Nightingale program has helped me take care of my health. I have become more aware of my peak flows. Using the app to log my peak flows meant I didn’t have to keep track on paper. Talking to the health coach reminded me about ways to take care of my asthma. My health goal was to have my asthma under control and get back to activities like jogging and singing. I have met ALL my goals!” Member with asthma, female, 71 years old

Additional testimonial from this member:

Addendum: “I had a follow up appointment with my pulmonologist in January (2022). My pulmonary function tests were improved! My Dr. was impressed by the results and how well I was breathing. I believe the improvement in my breathing and test results are because of my diligence using the tools provided by the Nightingale Program. I’m glad I decided to participate in the Nightingale Program, it has made a positive impact on my quality of life.”

Overall, the Nightingale way creates a self-sustaining cycle whereby patients see improvement in an area that’s tangible, understand what’s causing the improvement, and continue to adhere to what works because of our coaching, unparalleled leading indicator insights with ADAMM and our flexible touchpoints.

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