with focus on elderly population with multiple medications overview of readmissions tiffany a....
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WITH FOCUS ON ELDERLY POPULATION WITH MULTIPLE MEDICATIONS
OVERVIEW OF READMISSIONS
Tiffany A. FormbyHealthcare Design of the Future
September 29, 2011
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READMISSION DEFINED
• Returning to hospital within specified time period original admission• CMS time period focus is 30 days• Normally for the same issue
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READMISSION IMPORTANCE
•Hospital has to cover costs for readmission• Theory: their fault for patient returning?• Balance– longer stays in hopes for
rate
• Readmission rate important• Quality care metric
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SUBGROUPS
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Patients who:•Were hospitalized for heart failure • 6 month readmission rate as high as 50%
•Have multiple conditions• 1.17 odds with stroke, 1.17 with diabetes
•Stayed in hospital longer than 7 days• 1.52 odds
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SUBGROUPS
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Patients who:•Are taking 3 or more prescriptions
• Adherence problems increase exponentially
•Are elderly patients who fail to adhere to prescription plans• Attribute to 30% of hospital admissions
•Went to teaching hospitals• Study completed shows no significant
impact
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SUBGROUPS
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Patients who:•Received individualized care plan• Decrease in readmission rate in 7 studies
•Were confused by discharge instructions• Or not given instructions at all
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SUBGROUPS
• Factors and criteria contribute to higher likelihood• Combined, even higher likelihood!• Odds ratio (following heart failure admission)• Race• Caucasian 1.0 (baseline)• African American 1.05• Other 1.17
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FOR EXAMPLE…
Example: Non-white/ African American (1.17) & LOS >7 days (1.52)& hospitalized in last 6 months (1.67)& pre-existing diabetes (1.13)=3.35 odds! (just the last three conditions alone = 2.87
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FOCUS
• Non-adherence• 30% elders hospitalized• 125,000 deaths per year in US
• Medicare publishes these rates• Typically 65 to qualify for Medicare
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FOCUS
• Preventable more than other situations• Race, past hospitalization, etc
• Use technology to remember• Online, texting, audio cue reminder systems
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CASE STUDY
• Why elders forget to take medication?
• Which reminding system is most effective?• Visual-pervasive• Audio-portable• Text-wearable
(Lundell, Kimel, et al.) study supported by National Institute on Aging grants
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Take yourpill!
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CASE STUDY RESULTS
• 10 participants• With reminding systems, adherence increase
from typical 50-80% to 96%• Common reasons for other 4%• Away from home without medication• Had company over• Overslept• Slept in• Busy: on the phone, in the yard
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SECOND CASE STUDY
• 11 participants (mean age 83)• Use technology to improve non-adherence• Techniques similar to Aware Home• Sensors to track movement• Motion sensors in each room• On refrigerator• On phone line• On watch worn by subject• In bed
• Pillbox sensors to record adherence
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SECOND CASE STUDY
• This time- Rules for Reminders• Prompt at closest location• Don’t prompt if in bed• Wait until off phone
68.1% no reminders73.5% time-based reminder92.3% context-based reminder
(Hayes, et al.) study supported by National Institutes of Health grants
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MY SOLUTION
• Initial idea for a pill dispenser alarm clock• Similar to solutions in literature, Aware home• Elderly normally sleep in consistent bed• Issues- most pills taken twice a day
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MY SUGGESTIONS
• Complete similar case with reminder systems• Increase number of participants• Track among age groups• Under 65 would appreciate a reminder system• Is context-based improvement worth investment in
sensors, etc
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MY SUGGESTIONS
• Introduce whichever successful product in hospitals• Sell to hospital as part of care package to send
home with patients on multiple medications•Charge as a hospital supply on patient bill?
• Begin familiarizing patients with technology• Program timing to normal lifestyle (not hospital
time) to get in habit
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CONCLUSIONS
• Cost of readmissions in spotlight• $$$ on the mind
• Address subgroups
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REFERENCES
Aranda, J. M., J. W. Johnson, et al. (2009). "Current Trends in Heart Failure Readmission Rates: Analysis of Medicare Data." Clinical Cardiology 32(1): 47-52.
Batty, C. (2010). "Systematic Review: Interventions Intended to Reduce Admission to Hospital of Older People." International Journal of Therapy & Rehabilitation 17(6): 310-322.
Hayes, T. L., K. Cobbinah, et al. (2009). "A Study of Medication-Taking and Unobtrusive, Intelligent Reminding." Telemedicine Journal and E-Health 15(8): 770-776.
Kimel, J. and J. Lundell (2007). "Exploring the nuances of Murphy's Law---long-term deployments of pervasive technology into the homes of older adults." interactions 14(4): 38-41.
Lundell, J., T. L. Hayes, et al. (2007). Continuous activity monitoring and intelligent contextual prompting to improve medication adherence. 2007 Annual International Conference of the Ieee Engineering in Medicine and Biology Society, Vols 1-16: 6287-6290.
Lundell, J., J. Kimel, et al. (2006). Why elders forget to take their meds: A probe study to inform a smart reminding system, IOS Press.
Minott, J. (2008). "Reducing Hospital Readmissions." accessed on April 8: 2009.
Press, M. J., Jeffrey H Silber, Amy K Rosen, Patrick S Romano, Kamal M; F Itani, Jingsan Zhu, Yanli Wang, Orit Even-shoshan, Michael J Halenar, and Kevin G Volpp (2011). "The Impact of Resident Duty Hour Reform on Hospital Readmission Rates Among Medicare Beneficiaries." Journal of General Internal Medicine 26(4): 405-411.
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20 SECONDS FOR QUESTIONS?
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