July 30, 2012

Kevin J. Boyle

Hospital readmissions are coming under closer scrutiny as the federal government and healthcare industry attempt to contain skyrocketing medical costs. That’s because hospitalization alone accounts for around one third of overall healthcare spending. In recent efforts to control these expenses, the Patient Protection and Affordable Care Act (PPACA) mandated new financial disincentives around readmissions for hospitals. As a result, hospitals and health systems are looking for innovative ways to reduce readmission rates and improve outcomes for patients after hospitalization.

A hospital readmission is defined as the need for re-hospitalization that is often due to complications or re-emergence of health issues related to the original hospital stay. Although some readmissions are unavoidable, others are often preventable.

Many industry experts agree that a greater focus on transition care – easing the transition from hospital to residential and sub-acute facilities – is the key to preventing these readmissions. In a 2006 study published in the Archives of Internal Medicine titled “The Care Transition Intervention,” researchers identified four crucial areas that can support successful care transitions:

Assistance with medication management;

Timely follow up with a patient’s own primary and specialty doctors;

Electronic medical records; and

Patient education

Research also shows that early intervention is crucial, and outreach with patients should be made within days or even hours after discharge. All of these findings continue to be validated through academic studies and early models. As a result, they have become the basis for many of today’s transition care programs.

Communication: The key to preventing readmission

Successful transition care requires frequent communication with patients and real-time documentation – whether performed in-person or electronically. Many transition of care models have attempted to use telephone outreach simply because reaching patients in person at their homes is an expensive and unsustainable approach for large populations. Unfortunately, telephone-based outreach is fairly limited and lacks the visual cues to accurately assess recovery and compliance.

For example, telephone calls require patients to describe their own recovery, ambulation and other very subjective measures. In addition, many hospitals and health systems have decided to outsource these functions to wellness vendors – another approach that can be costly, time-consuming and inefficient.

As a result of these limitations, telemedicine has become a natural fit for building cost-effective, convenient and comprehensive models for transition of care. By reaching out to individuals via telemedicine after discharge, hospitals are able to extend their face time with patients, provide personalized support and assess recovery in real time. When properly implemented with the most advanced equipment, including mobile workstations, telemedicine can be easily integrated with existing systems and processes to form an extension of the internal hospital staff’s everyday roles.

Telemedicine gives transition care teams a way to reinforce patient education that goes far beyond written instructions and follow-up phone calls. For instance, the latest telemedicine technology can allow nurses to check a patient’s vitals remotely while high definition video capabilities allow for detailed assessment of recovery indicators such as wound healing.

Since medication management is a key indicator of successful transition care, physicians and their staff can view and assist patients with the proper use of medications and supplements. Providers can even demonstrate basic physical therapy exercises and self-care to speed post-surgery healing.

Telemedicine provides an ideal option for extending communication to caregivers and family members, since they are often an important part of a patient’s support system. While patients may provide one account of their recovery and treatment compliance, their loved ones can provide a more objective, third-person perspective. This is especially true with aging patients who may have issues with cognition or memory. Most importantly, by extending a forum for everyone involved in their care, telemedicine can offer patients greater peace of mind, encouragement and support.

Supporting patient care innovations

Telemedicine is a cost-effective means of reaching a large patient population with a limited staff of providers. Rather than outsourcing transition of care programs, healthcare organizations can now allocate their own internal resources to quickly and efficiently reach out to patients immediately after hospitalization.

Telemedicine also coincides with the shift to electronic patient records. State-of-the-art telemedicine solutions can connect with existing systems to update patient data seamlessly. Since documentation is done in real-time, the data can be shared with all of a patient’s providers and transition care team immediately.

Hospitals looking for new and better ways to reduce readmissions and improve quality of care would benefit from telemedicine solutions that connect providers, residential care teams, patients and their loved ones. As other new models of patient care emerge and change the way care is delivered, telemedicine will continue to provide a convenient, effective platform for providing patient-centered care.

Kevin J. Boyle is business leader for the telemedicine team at Rubbermaid Healthcare in Huntersville, N.C.


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