ACC: Philips stresses hospital-to-home connections
NEW ORLEANS—As the feds and payors focus on curbing readmission rates, hospitals and caregivers need to revisit management of the hospital-to-home transition. Philips Healthcare shared a new multi-vendor, multi-disciplinary model during the annual meeting of the American College of Cardiology (ACC).

“Patients leaving the hospital do not want to return anytime soon, yet many find themselves back in the hospital within 30 days. It has been shown that better patient outcomes are a result of not only the care received while in the hospital, but also the care at home,” said Henry A. Solomon, MD, chief medical officer at the ACC.

“The ACC recently conducted an online survey of its members and ACC.11 attendees and found that the majority of cardiologists believe there should be an increased focus on reducing hospital readmissions, and that attention should be directed to the hospital as well as the ambulatory and home settings. There seems to be consensus that more work needs to be done both inside and outside the hospital to reduce readmissions.”

Philips pointed out that although incentives are not currently aligned to reduce readmissions, the paradigm will reverse on Oct. 1, 2012, when Medicare will no longer reimburse for heart failure and acute MI patients who are readmitted within 30 days of their initial hospital stay.
A 2009 study published in the New England Journal of Medicine demonstrated that approximately 20 percent of MI patients bounce back into the hospital within 30 days of the initial visit. The corresponding rate for heart failure patients is about 25 percent, according to the study.

“We need to do a better job of managing the discharge process and supporting recovery,” stressed Kevin Geary, Philips' cardiology care cycle director. The problem, continued Geary, is two-fold. Patients need to be better educated about managing their disease at discharge, and monitoring systems to alert providers to early warning signs of problems need to be deployed post-discharge.

The Hospital to Home (H2H) Learning Destination at ACC.11 walked visitors through three patient scenarios and illustrated how technology could improve patient management and outcomes. Technologies showcased in the demonstration included:
  • PageWriter TC70 with DXL algorithm, which provides clinical decision support for up to 16-lead ECG;
  • iE33 ultrasound with xMATRIX;
  • MRx hospital defibrillator;
  • Philips CVIS and Xcleera cardiology PACS;
  • MP5 SC bedside monitoring with early warning;
  • Cableless progressive care monitoring;
  • Telehealth center;
  • Remote cardiac service with diagnostic arrhythmia monitoring, ICD monitoring and PT/INR patient self-testing;
  • Home telehealth systems;
  • Automated medication dispensing.

The H2H Learning Destination focused on three patients: Jose, an acute MI patient treated with a stent and subsequently diagnosed with sleep apnea; Brian, a stage III heart failure patient with diabetes, hypertension and sleep apnea; and Maria, an 82-year old suffering worsening atrial fibrillation despite a transcatheter aortic valve replacement and antiarrhythmic medications.

Jose’s hospital stay entailed standard clinical systems such as echocardiography and 16-lead cardiograph, with patient data stored in the cardiology information system. Other components were cableless monitoring of NBP SpO2, sleep diagnostics, a hospital registry for MI patients and discharge planning including risk stratification.

After discharge, Jose was provided with a CPAP sleep therapy system and an activity monitor in the home. Other tools to engage the MI patient in his care included social media and a personal health record. Community providers also were engaged in Jose’s care through sleep diagnostics and sleep apnea monitoring, a centralized telehealth center and 30-day readmission risk profiling.

Brian received similar in-hospital services. However, his stay included placement of a CRT-D implant. Bedside patient education and a patient monitor with an early warning system and centralized monitoring were employed in the hospital. This centralized telehealth center incorporates two-way audio and video capabilities and allows nurses to escalate care as needed.

Post-discharge, Brian’s plan included diuresis center monitoring, sleep diagnostics, sleep apnea monitoring, supplemental oxygen, home telehealth monitoring, remote cardiac monitoring and remote monitoring transmitters. Instructive components included social media, a personal health record and patient education. An automated medication dispensing system helped Brian to manage multiple medications. Brian also was enrolled in an ambulatory quality improvement registry.

Maria’s comprehensive plan was similar to the other patients' plans. Specific hospital needs included an aortic valve implant. The cardiology team assessed her condition via echocardiography, 16-lead cardiograph and centralized patient monitoring. The cardiology information system linked various elements.

Post-discharge, Maria’s plan included home telehealth monitoring and remote cardiac monitoring managed by a centralized telehealth center. Physicians prescribed a Holter monitor, PT/INR meter and home defibrillator. She also used the automated dispensing service, which was programmed to alert providers if she missed a dose. Finally, Maria was enrolled in an ambulatory quality improvement registry.

Providers stressed that a comprehensive model that weds education, multidisciplinary management and consistency and standardization is key to addressing the readmission challenge.