WITH FOCUS ON ELDERLY POPULATION WITH MULTIPLE MEDICATIONS

OVERVIEW OF READMISSIONS

Tiffany A. FormbyHealthcare Design of the Future

September 29, 2011

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

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

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

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!

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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