Khatereh Hadi and Laura Sims Improving Communication in Home
Healthcare Reducing Hospital Readmissions
Slide 2
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
Slide 3
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. Intro Problem
Statement Literature Review Existing Products Goals Proposed
Solution 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.
Slide 4
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. Intro Problem Statement Literature Review Existing
Products Goals Proposed Solution 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. Elderly Patients: a big
proportion of home care target group
Slide 5
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 Baile WF, 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. Intro Problem Statement Literature Review Existing
Products Goals Proposed Solution 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.
Slide 6
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. Intro
Problem Statement Literature Review Existing Products Goals
Proposed Solution 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. Caregivers life experience self-confidence emotional
states cognitive and physical abilities Knowledge Patients
emotional state Complex medication needs Affect communication
quality Demands careful and structuresd communication
framework
Slide 7
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%) Intro Problem
Statement Literature Review Existing Products Goals Proposed
Solution 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.
Slide 8
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 Intro Problem Statement Literature Review
Existing Products Goals Proposed Solution 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.
Slide 9
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 Intro Problem Statement Literature Review Existing
Products Goals Proposed Solution Seven percent of U.S. physicians
use video chat to communicate with patients. 17 May 2011.
http://www.fiercehealthcare.com/press-
releases/seven-percent-us-physicians-use-video-chat-communicate-patients-1.
Slide 10
Existing Products Intro Problem Statement Literature Review
Existing Products Goals Proposed Solution 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
Slide 11
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
Slide 12
Existing Products Intro Problem Statement Literature Review
Existing Products Goals Proposed Solution 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
Slide 13
Existing Products Intro Problem Statement Literature Review
Existing Products Goals Proposed Solution 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
Slide 14
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
Slide 15
Atlanta Hospice Technlogies : PT/INR machine: to read patients
blood clotting tendency (coagulation) Telemonitoring: to read blood
pressure
Slide 16
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
Slide 17
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
Slide 18
Atlanta Hospice MedPORTAL :help physicians automate their
entire day across all care settings
Slide 19
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.
Slide 20
Problems with existing home care system and technologies Not
all the devices are available for patients; nurses and physicians
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 dont 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.
Slide 21
Goals Intro Problem Statement Literature Review Existing
Products Goals Proposed Solution Improve Communication Improve
Adherence Decrease Cost
Slide 22
Proposed Solution Intro Problem Statement Literature Review
Existing Products Goals Proposed Solution Cost effective method of
using videoconferencing for home healthcare patients Bundled data
plan Secure connection platform Simple interface Transferable
hardware
Slide 23
Care Network Interface HospiceHome Patient MedHome PT/INR
Physician Nurse Social worker Hospital Med Lucker Pharmacy
