Transcript Slide 1

Improving Communication in Home Healthcare
Reducing Hospital Readmissions
Khatereh Hadi and Laura Sims
Problem Statement
 Home healthcare patients require providers to visit them
within their homes. Many of these patients require frequent
visits and face difficulties with communication with their
provider between visits. Failure to adhere to their medical
regiment often causes these patients to be unnecessarily
readmitted to the hospital.
Alternate modes of
communication could improve adherence of home healthcare
patients to their proper health regiment.
Intro • Problem Statement • Literature Review • Existing Products • Goals • Proposed Solution
Elderly Patients: a big proportion of
home care target group
 According to our case study, more than 50% of patient
receiving home care services are elderly people. Regarding
the existing literature on the high rate of readmission for
elderly people, improving quality of care in home care
settings would decrease hospital readmission rate.
 Elderly patients discharged to the community from hospitals
face a higher risk of reentering the health care system .The
rate of recidivism has been documented; it ranges from 17%
to 38% in different studies.
Fethke, C. C., I. M. Smith, et al. (1986). "" Risk" factors affecting readmission of the elderly into the health care system." Medical care: 429-437.
Intro • Problem Statement • Literature Review • Existing Products • Goals • Proposed Solution
Elderly Patients: a big proportion of
home care target group
A study shows that about 59% of unplanned readmission of elderly
people are avoidable, pointing out seven reason for readmission:
 Relapse of original condition
 Development of new problem
 Caregiver problems
 Complication of illness
 Need for terminal care
 Problems with medication
 Problems with services
Many of these problems can be solved through a good communication
with caregivers.
Lau, D. T., R. Berman, et al. (2010). "Exploring factors that influence informal caregiving in medication management for home hospice patients."
Journal Of Palliative Medicine 13(9): 1085-1090.
Intro • Problem Statement • Literature Review • Existing Products • Goals • Proposed Solution
Communication, one of the key factors
in palliative care
 Arnold B.,2011: Communication is a key currency for
delivering optimal palliative care which is possible trough:
(1) developing more comprehensive clinical-patient
needs assessment tools;
(2) improved patient-clinician communication
 BaileWF, Aaron J: Excellent communication is central to the
overall practice of navigation and to palliative care. Good
communication between physician and patient can help in
navigating the transition to palliative care and hospice.
Arnold, B. (2011). "Mapping hospice patients' perception and verbal communication of end-of-life needs: an exploratory mixed methods inquiry."
BMC Palliative Care 10(1): 1.
Baile, W. F. and J. Aaron (2005). "Patient-physician communication in oncology: past, present, and future." Current opinion in oncology 17(4): 331.
Intro • Problem Statement • Literature Review • Existing Products • Goals • Proposed Solution
Communication is important, but the
quality is more important.
 caregivers’ good interpersonal relations with patients
facilitated medication management, whereas poor
communication/relations among caregivers within a support
network impeded the process.
Caregivers’ life experience
self-confidence
emotional states
cognitive and physical abilities
Knowledge
Patient’s emotional state
Complex medication needs
Affect communication quality
Demands careful and structuresd
communication framework
Lau, D. T., R. Berman, et al. (2010). "Exploring factors that influence informal caregiving in medication management for home hospice patients."
Journal Of Palliative Medicine 13(9): 1085-1090.
Intro • Problem Statement • Literature Review • Existing Products • Goals • Proposed Solution
Literature Review
Use of videophones for seniors and hospice providers
 Seniors found it easy to use (71%)
 Willing to accept technology
 Hospice providers could use (85%)
Oliver D, Demiris G, Porock D. “The usability of videophones for seniors and hospice providers: a brief report of two studies”. Computers in
Biology and Medicine 35(2005) 782-790.
Intro • Problem Statement • Literature Review • Existing Products • Goals • Proposed Solution
Literature Review
Use of Telemonitoring Systems
 Patients can be monitored from the comfort of their home
 Periodically acquire vitals (eg. blood pressure, heart rate)
 Increasingly common for devices to be wireless
 Need to be integrated with healthcare information systems
Galarraga M, Serrano L, Martinez I, et al. “Telemonitoring Systems Interoperability Challenge: An Updated Review of the Applicability of
ISO/IEEE 11073 Standards for Interoperability in Telemonitoring”. Grant work from the Spanish Ministry of Science and Education.
Intro • Problem Statement • Literature Review • Existing Products • Goals • Proposed Solution
Literature Review
Manhattan Research survey of physician digital adoption
 7% of physicians use online video conferencing to
communicate with patients
 Used for follow-up questions or for geographically diverse
patients
 Barriers: HIPAA and lack of reimbursement
“Seven percent of U.S. physicians use video chat to communicate with patients.” 17 May 2011. http://www.fiercehealthcare.com/pressreleases/seven-percent-us-physicians-use-video-chat-communicate-patients-1.
Intro • Problem Statement • Literature Review • Existing Products • Goals • Proposed Solution
Existing Products
Telemonitoring
• Bosch Health Buddy
• Connects patients to their
care providers
• Providers can monitor and
take action
http://www.bosch-telehealth.com/content/language1/html/5578_ENU_XHTML.aspx
Intro • Problem Statement • Literature Review • Existing Products • Goals • Proposed Solution
Existing Products
In May 2011, after a one year launch
• 30% of U.S. physicians own an iPad
• 28% plan to purchase in the next 6 months
• 81% of physicians own a smartphone
Taking the Pulse® U.S. v11.0. Manhattan Research
Intro • Problem Statement • Literature Review • Existing Products • Goals • Proposed Solution
Existing Products
In Denmark, patients can
visit their doctor from
home using simple medical
devices and a notebook
computer with a Web
camera.
Bhanoo, Sindya N. “Denmark Leads the Way in Digital Care”. 11 Jan 2010. http://www.nytimes.com/2010/01/12/health/12denmark.html
Intro • Problem Statement • Literature Review • Existing Products • Goals • Proposed Solution
Existing Products
Online Care for Providers
• Service for care providers
• Sets up live encounters
through video, audio, and chat,
and sets up payment
automatically
http://onlinecareforproviders.com/index.php
Intro • Problem Statement • Literature Review • Existing Products • Goals • Proposed Solution
Atlanta Hospice
 Services:
 Home healthcare
 Home visit: physicians, nurse practitioners, social workers
 5-6 days a week: nurse visit
 1-3 days a week: physician visit
 2.2-2.5 days a week: social workers
 telemonitoring
 Hospice
Atlanta Hospice
 Technlogies :
 PT/INR machine:
 to read patient’s blood clotting tendency (coagulation)
 Telemonitoring:
 to read blood pressure
Atlanta Hospice
 Med Home Unit: medical alarm system
 Can record and play approximately eight 15-second audio reminder
messages.
 Emergency bottom: connected to the 24-hour call center specialist who
can communicate with the patient
Atlanta Hospice
 Med Lucker: medication storage and emergency kit
 To pick up medicine, no more waiting.
 Stores and tracks a variety of emergency and first-dose medications at health care facilities
Atlanta Hospice
 MedPORTAL :help physicians automate their entire day
across all care settings
Atlanta Hospice
 Document imaging system: electronic recording mechanism, it
takes a paper medical record and creates a universal electronic
patient medical record that is easily managed.
Problems with existing home care
system and technologies
 Not all the devices are available for patients; nurses and physicians
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are responsible to use and apply them.
Not all the households have the LAN and internet access
People key information in, errors are possible.
Information are passively collected and they are not actively used
by caregivers.
Data are not integrated.
Patients are willing to use the devices, by they don’t want
commitment.
Patients are different in medical adherence.
The costs are too high.
Only visits are covered by Medicare, not telemonitoring and other
far distance technologies.
Goals
Improve Communication
Improve Adherence
Decrease Cost
Intro • Problem Statement • Literature Review • Existing Products • Goals • Proposed Solution
Proposed Solution
Cost effective method of using
videoconferencing for home
healthcare patients
• Bundled data plan
• Secure connection platform
• Simple interface
• Transferable hardware
Intro • Problem Statement • Literature Review • Existing Products • Goals • Proposed Solution
Care Network
Hospice
Hospital
MedHome
Nurse
Med
Lucker
Pharmacy
Home
Physician
Social
worker
Interface
Patient
PT/INR