Overview of Readmissions

With focus on elderly population who take multiple medications

Tiffany A. FormbyHealthcare Design of the Future

September 29, 2011

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Pieces to the

readmission problem

Note: NOT an exclusive list

Medication non-

adherence

Retained foreign objects

Managing multiple conditions

Access to resources at home

Involving family

Unclear discharge

instructions

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In hospital

Discharge transition

At home ???

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Is it really the hospital’s fault?

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In hospital

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Discharge transition

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At home

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Race1

1.1

1.2

1.3

1.4

1.5

1.6

1.7

1.8

11.05

1.17

Caucasian (baseline)African AmericanOther

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For example…

Condition1

1.1

1.2

1.3

1.4

1.5

1.6

1.7

1.8

1.52

1.67

1.131.17

LOS >7 daysHospitalization in last 6moDiabetesStroke

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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11

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Take yourpill!

First case study

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96%50-80%

Before After

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Second case study

• 11 participants (mean age 83)• Use technology to improve non-adherence• Techniques similar to Aware Home– Motion sensors– Pill weight sensor

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Second case study

• This time- Rules for Reminders

No prompt Time-based Context-based0

20

40

60

80

100

68.173.5

92.3

Adherence

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Initial Idea

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My suggestions

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Factors:CapacityWeight (portability)Reminder (alarm)

Cheap (THIS IS $249.95 – you can get an iPhone cheaper than that!)

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Address each piece of the puzzle Apply improvement tools:

ProcessDesign/ Built EnvironmentTechnologyClinical Knowledge