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Informatics tool for preventing Congestive Heart failure rea

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Venkata Sunkesula

on 23 January 2014

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Transcript of Informatics tool for preventing Congestive Heart failure rea

Preventing Congestive Heart failure readmissions: A clinical informatics tool

Venkata C.K. Sunkesula

Problem ?
Centers for Disease Control
and Prevention (CDC)
Leading cause of hospitalization
among adults >65 years

270,000
who are on Medicare are readmitted
within
30 days

Expenses:
$ 17.4 Billion per year
for unplanned
readmissions, and heart failure is the most
frequent reason for readmission

Lower reimbursement to hospitals with excess risk-standardized readmission rates
Centers for Medicare and Medicaid Services (CMS)
30-day readmissions are frequent throughout the
month following hospitalization and result from a similar spectrum of readmission diagnoses
regardless of age, sex, race, or time after discharge.
Informatics tool
Evidence
Poor adherence to heart failure medications increased the number of cardiovascular-related emergency department (ED) visits

Ho et al. 2009, Circulation
Informatics Proposal
Previous studies have identified the
modifiable risk factors for CHF readmission

I. To develop a clinical decision support system- using these high risk variables

II. To develop a Web-based post discharge communication tool to improve adherence to the management plan
Modifiable risk factors for Readmission
Readmission
Non-compliance
MEDICATION
Non-compliance
DIET
Social Isolation
Lack of Exercise
Rich et al. NEJM; 1995
Tabak et al. Med Care; 2007
Prediction
Socio-economic factors
Education <8th grade
Live alone
History of drug abuse
History of depression
Low socio-economic status
Tabak et al. Med Care. 2007
RED Team
Cardiovascular physician
Research nurse: > 5 years of experience
Nutritionist
Social care worker


Normalization Process Theory
(NPT)
Collective action
Skill set workability:
How does the innovation effect roles and responsibilities or training needs?
Interactional workability
:

Does the e-health service make peoples work easier?
Contextual integration/Relational integration
:

Is there organizational support/do individuals have confidence in the new system?
CDSS: Computerized Decision Support System
Data
ICD -10 codes
SNOMED-CT
LOINC
RxNorm

Additional data
Free-text clinical notes
Patient feedback
Feedback from social care workers
Feedback from the research staff
Medical Query Structure
Intervention focused
Pre-filters
ICD-10 code- Congestive heart failure
Education <8th grade
Lives alone
H/O Depression (ICD 10)
H/O Drug abuse (ICD 10)
Internet /Cell phone web access
Intervention
CDSS

Web-based post discharge communication
Outcome
Adherence to Medication - LOINC
Adherence to Diet - LOINC
Adherence to Exercise - LOINC
Regular follow-up visits
Decreased ED visits
Decrease in the readmission rates
Horskey et al. Design of decision support interventions for medical prescribing. Int J Med Info, 2013
Website Education
Data Input and Online support group:

30 minutes of instructions by the researchers to patients on how to input the data into the website and how to participate in the online discussion forum

Once a week: Patient's would enter the data whenever its convenient once a week (Blood pressure, Medication dosage, time spent on exercise, diet, weight)

Data collected would be transported to the internet server system and automatically displayed on the patient's electronic chart

The RED team goes through their reports and gives their recommendation to the patient after consulting the physician.

Park MJ. Int J Med Inform; 2009
NPT

Differentiation:
Online communication, monitoring, and support groups
Communal specification
Individual specification
Internalization
Cognitive participation
Enrollment
Activation
Initiation
Legitimation
Coherence
Online support groups
Google hangouts/ Skype/ V-tel

Patient's experiences with adherence to management

Patient education: Latest information in the field of CHF

http://www.mdjunction.com/congestive-heart-failure/video?v=tracking-heart-condition-from-home-460692417
Evidence

Better informed
Enhanced social well-being
More confident in the relationship with their physician and staff
Feeling more confident about the treatment and increased optimism and control
Kraan et al. Patient Educ Couns, 2009
Hoybe et al. Psychooncology, 2005
Reflexive Monitoring
Reconfiguration
Communal appraisal
Individual appraisal
Systematization

? Increased adherence to management

? Reduced Re-admissions

Limitations

Internet access to
all the patients??
Thank You
Patient admission flow chart

Reflexive Monitoring
Reconfiguration - try to alter the new service?
Communal appraisal - How do groups
judge the value of e-health service
Individual appraisal
Systematization: benefits or problems identified or measured
Full transcript