By David Lee Scher, MD (12/16/2011)
Patients who are discharged from the hospital after a heart attack, congestive heart failure, or pneumonia have high rates of short-term readmissions. As per a provision in the Affordable Care Act, a Medicare patient with one of these diagnoses who is readmitted within 30 days for the same will trigger a denial of reimbursement for the subsequent admission. There are many things which need to change to limit these events, though not all readmissions can be prevented, as nothing in medicine is absolute. Identification and intensive interventions (inpatient and post-discharge) with high risk patients, better communication/care coordination, discharge processes, and patient education have been shown to produce results. I would make a case for mHealth to become an integral part of all these components of a multi-faceted solution. Here are a few ways that mHealth may be incorporated in the process:
1. The use of bioinformatics to determine the patient’s low, moderate, or high risk of readmission can be put into a hospital app to be shared among members of a multidisciplinary transitional team, which will formulate a discharge and post-discharge plan based on this data, while rounding on the patient daily.
2. Bedside computer tablets can be used by nurses and other providers utilizing one of the good patient education tools available. The patient and caregiver may continue to have access to these programs at home, and tracking of the time spent with these programs can be used to study the correlation between this education and discharge instruction adherence.
3. Mobile apps with cloud-based patient portals may be shared with the primary care physician and post-hospital institutions (nursing/assisted living, rehab, LTAC, etc) at the time of discharge, with follow-up appointments made with providers with the same program.
4. Mobile technologies for instruction and medication adherence may be activated with the patient and caregiver prior to discharge. This will involve the caregiver before the last minute, as well as decreasing anxiety related to a hurried discharge process.
5. Telehealth conferencing with expert providers/extenders to supplement remote sensor monitoring would benefit patients at high risk for readmission.
This is a simplistic description of a complex disruption of hospital culture. The above ideas are neither new nor solely my own. 90% of hospitals say they are aware of and addressing the issue of readmissions. However, few hospitals are attacking this issue in a concerted and comprehensive fashion. Significant changes in the utilization of personnel, investment in technology, and a commitment to making the patient the center of healthcare are imperative for success of not only preventing readmissions, but of care in general.
About David Lee Scher, MD
Dr. Scher is a medical pioneer (earliest adopter of remote patient monitoring and interoperability with EHR), a lifecycle contributor to development of new technology and regulatory approval as a clinical investigator, and a Medicare Carrier Advisory Committee member. He writes a blog on mHealth and can be reached by email or through Linkedin.
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