Ny Presbyterian Quality Symposium

NewYork-Presbyterian Healthcare System

Post Reform Strategies: Pragmatic ApproachesQuality Symposium 2010

to Improving CarePilot Study on the Effects of Medication Telemonitoring on Medication Compliance and the Rates of Re-Hospitalization in CHF and Pneumonia Patients

J. Pinto, RPH MS; A. Farkas, PharmD; N. Tsirkas; B. Rapchack; M. Rader, MDNyack Hospital

Nyack Hospital is collaborating with Leap of Faith Technologies in a pilot study of the effects of a cellphone-based medication telemonitoring system on rates of re-hospitalization in CHF and pneumonia patients. The system integrates cell phones, radio frequency identification (RFID), and health and behavioral informatics to optimize medication adherence, track medication use, and extend patient care to the ambulatory setting. It provides real-time, automated feedback on the patient's medication compliance and documents compliance on a dose-by-dose basis. It can also send automatic alerts to enable early intervention in the case of missed medications or adverse events before they become a serious health risk.

ProblemMedication compliance has been called the Achilles heel of modern healthcare. The average rate of compliance is only 50% and continues to decline. Noncompliance is associated with nearly 70% of all medication-related hospital admissions at an estimated annual cost of $100 billion. More specifically, according to Medicare claims data from 2003-2004, 19.6% of Medicare beneficiaries who had been discharged from a hospital were re-hospitalized within 30 days, and 34.0% were re-hospitalized within 90 days. The Medicare Payment Advisory Commission (MedPac) - in a report to the Congress in June 2007 - estimated that approximately three-quarters of readmissions were preventable -- amounting to $12 billion in annual Medicare spending.

GoalsTo facilitate transitional care from the acute to post-acute setting using a drug telemonitoring system, resulting in: 1. Improved compliance with prescribed therapy 2. Reduced rates of re-hospitalization

MethodsIn this current transition care study, efficacy will be evaluated in a sample of patients being discharged from the hospital after being treated for CHF or pneumonia, and taking at times more than 20 prescription and over the counter medications daily (n=20). Subjects in the Test group will use the telemonitoring system; subjects in the Control group will be historical controls. At the time of discharge, all of the patient's medications are entered into the eMedonline system, and wirelessly downloaded to the phone for the patient. The pharmacist counsels the patient about his/her medications, including the name of medication, strength, dosage form, quantity, dose, frequency, time taken, indication, instructions on how to take the medication, and additional instructions as required, and gives the patient the eMedonline phone to use for 30 days. The patient also receives "smart labels" (a label with RFID inlay) for each medication, which are affixed to the medication vial or packaging. Each patient in the Test group receives a follow-up phone call from the pharmacist at days 7, 14, 21 and 30 post-discharge and is given instructions about the medication being taken. Data on compliance rate and average compliance time are collected by the mobile device for the Test Group, and compared to historical data in the Control Group. Rates of re-hospitalization between the two groups will also be compared.

ResultsTo date, eight patients have enrolled in the pilot study. The Test group has thus far demonstrated 98.3 % compliance over the 30 day study period (n= 6) for 2,317 scheduled doses. One subject's participation was terminated early due to personal reasons. Average compliance time was 6.24 minutes (the average time it takes a patient to report a doses that it was taken). Rate of hospital readmission for patients who have completed the 30 days enrollment is 0% to date (n= 5).

Introduction

Nyack HospitalQuality Symposium 2010 Post Reform Strategies: Pragmatic Approaches to Improving Care

Page 119

NewYork-Presbyterian Healthcare System

Post Reform Strategies: Pragmatic ApproachesQuality Symposium 2010

to Improving CarePilot Study on the Effects of Medication Telemonitoring on Medication Compliance and the Rates of Re-Hospitalization in CHF and Pneumonia Patients

J. Pinto, RPH MS; A. Farkas, PharmD; N. Tsirkas; B. Rapchack; M. Rader, MDNyack Hospital

ConclusionsThe main outcomes of the pilot study will serve as the basis for a larger study with sufficient statistical power to evaluate the true effects of the telemonitoring system on the rates of hospital readmissions. In addition, there are many other opportunities to explore the use of such technology in improving communication between healthcare professionals related to medication management and medication reconciliation in the continuum of care. Cellphone-based medication telemonitoring may overcome some of the limitations of current methods used to manage transition care. Current transitional care models frequently use a disease management approach, assigning a case worker to track and coach the patient upon discharge. Follow-up office visits are typically scheduled 14 days or more after release—the timeframe in which most readmissions occur. Of Medicare beneficiaries readmitted within 30 days, 64% received no post acute care between discharge and readmission. During this critical period, there is no system to consistently and efficiently monitor the status of the patient and provide timely feedback. eMedonline integrates the patient, caregiver, and provider into the transition care plan, providing an important touch point that is available 24/7.

Nyack HospitalQuality Symposium 2010 Post Reform Strategies: Pragmatic Approaches to Improving Care

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