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Informatics tool for preventing Congestive Heart failure rea
Transcript of Informatics tool for preventing Congestive Heart failure rea
Venkata C.K. Sunkesula
Centers for Disease Control
and Prevention (CDC)
Leading cause of hospitalization
among adults >65 years
who are on Medicare are readmitted
$ 17.4 Billion per year
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.
Poor adherence to heart failure medications increased the number of cardiovascular-related emergency department (ED) visits
Ho et al. 2009, Circulation
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
Lack of Exercise
Rich et al. NEJM; 1995
Tabak et al. Med Care; 2007
Education <8th grade
History of drug abuse
History of depression
Low socio-economic status
Tabak et al. Med Care. 2007
Research nurse: > 5 years of experience
Social care worker
Normalization Process Theory
Skill set workability:
How does the innovation effect roles and responsibilities or training needs?
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
ICD -10 codes
Free-text clinical notes
Feedback from social care workers
Feedback from the research staff
Medical Query Structure
ICD-10 code- Congestive heart failure
Education <8th grade
H/O Depression (ICD 10)
H/O Drug abuse (ICD 10)
Internet /Cell phone web access
Web-based post discharge communication
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
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
Online communication, monitoring, and support groups
Online support groups
Google hangouts/ Skype/ V-tel
Patient's experiences with adherence to management
Patient education: Latest information in the field of CHF
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
? Increased adherence to management
? Reduced Re-admissions
Internet access to
all the patients??
Patient admission flow chart
Reconfiguration - try to alter the new service?
Communal appraisal - How do groups
judge the value of e-health service
Systematization: benefits or problems identified or measured