The PRAXIS Nexus The PRAXIS Nexus

The Next Phase of COPD Care: Innovation

Posted on September 22, 2015   |   
2 Comments   |   
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Innovation

If you are reading this blog post, you are probably looking (like me) for solutions to the issue of COPD readmissions. For a multitude of reasons, our current processes just have not had the impact we need. The status quo has not moved the needle on readmissions in the direction or to the degree that we have all wanted.

As we begin to adapt to a financial model that pushes results and not volume, we have to explore other solutions to decrease readmissions and think more proactively to prevent that index admission, as well. The Triple Aim is driving us to improve the patient experience, the health of populations and to reduce the cost of care. It is time to disrupt what we know and look elsewhere. It is time for innovation.

Through innovative technology like tele-monitoring, tele-health and wearables, providers can access previously unavailable clinical information while patients can recognize and respond in real time to triggers. With the support of virtual visits, first-line healthcare providers can triage who needs to be seen on site and who can be treated by video consult.

Technology can also allow us to identify barriers earlier and, in turn, take more immediate action. For example, a patient may think he can afford a medication co-pay while hospitalized. Once at the pharmacy, however, he realizes the cost is prohibitive and does not purchase the medication. Through tele-health, a nurse checking in with him the day after discharge catches this in her review; the nurse is able to research and discuss immediate solutions with the patient rather than waiting for longer-term outcomes (which may include an emergency room visit).

Technology can add great value to being more proactive in monitoring and tracking progress in the home as well as staying on top of the situation. For example, the patient who has a tele-monitor and a blue tooth scale that gains four pounds in a day and reports shortness of breath can share real-time data, including vital signs, with her physician. Now a member of the care team, the patient and her physician share in the decision to trigger a home health nurse visit to utilize a Lasix protocol in her home, averting another readmission.

Innovative technology can also be central to patient empowerment. Some of the current wearables and sensors collect data without interfering in the lives of patients and caregivers. These data, coupled with patient education, equip patients to make credible and sound, informed decisions on their own and can help to prevent that unnecessary trip to the emergency room.

We know that the real drivers of healthcare must be the patients and caregivers. After all, who else cares more about their health outcomes than the patient? If we empower them with the right education, tools to help decipher their symptoms and develop simple steps for them to follow, we can catch potential problems and barriers before it is too late.

In the coming months, I will write and share how some of these innovative solutions can be piloted and tested and with research and outcomes measurement can be incorporated to define not only best practice but evidence-based practice.

Please join me in sharing some of your real-world experiences with innovation in the comments – maybe around other technology, ethnography, big data, analogous learnings, predictive analytics or design thinking.

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  • Deb,
    I agree that technology can further our goal of The Triple Aim. However, we need to do better at identifying those patients who have the greatest need for additional services. Below is an interesting article regarding which patients may need extra care.

    Early and Long-Term Outcomes of Older Adults Following Acute Care Encounters for Chronic Obstructive Pulmonary Disease Exacerbation


    Read More: http://www.atsjournals.org/doi/abs/10.1513/AnnalsATS.201504-250OC#.VglsqE3bKJA

    RATIONALE: Older patients are at high risk of death and re-hospitalization following hospitalizations for acute exacerbations of chronic obstructive pulmonary disease (AE-COPD). Emergency department visits comprise a substantial portion of acute care encounters in this patient population. The risks of mortality and repeat acute care encounters, including both hospital readmission and repeat emergency department visits, following AE-COPD among older adults are not well understood. OBJECTIVES: To examine early and long-term rates of death and repeat acute care encounters following hospitalization or emergency department visit for AE-COPD in Medicare fee-for-service beneficiaries, and to identify patient characteristics, including medical comorbid conditions, associated with these outcomes. METHODS: A retrospective analysis was conducted using a nationally representative 5% sample of Medicare fee-for-service claims data from the U.S. Centers for Medicare and Medicaid Services to identify Medicare beneficiaries 65 years or older who had an acute care episode for an AE-COPD between January, 1, 2006, and December 31, 2010 (n=52,741). Outcomes of interest were all-cause mortality, repeat acute care encounters for any cause, and repeat acute care encounters for AE-COPD at 30 days, 1 year, and 3 years. MEASUREMENTS AND MAIN RESULTS: Acute care encounters including hospitalizations and emergency department visits for AE-COPD were associated with substantial subsequent mortality risk, with 4.6%, 24.4% and 48.2% dying by 30 days, 1 year, and 3 years, respectively. The risk of repeat hospitalization or emergency department visit was similarly high, with 1 in 4 patients having a repeat acute care encounter within 30 days of discharge, increasing to 9 in 10 in the next 3 years. Several comorbid conditions and other patient factors, including heart failure, malnutrition, dual eligibility for Medicare and Medicaid, and prior supplemental oxygen use, were independently associated with increased risk of repeat acute care encounter. CONCLUSIONS: Repeat hospitalizations and emergency department visits and death are common in older fee-for-service Medicare beneficiaries seen in acute care for AE-COPD. Our results suggest that addressing important comorbid conditions, such as heart failure or malnutrition, and targeting resources to oxygen-dependent or dual Medicare- and Medicaid-eligible patients may help modify these outcomes.

    Reply
    • DeNay -- thank you so much for posting this article -- I'll make sure to get it in the Resource Repository too!
      Reply

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