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Overview of Readmissions
With focus on elderly population who take multiple medications
Tiffany A. FormbyHealthcare Design of the Future
September 29, 2011
???
2
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
3
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