There was an interesting report issued by a committee of the American Thoracic Society, examining strategies to reduce readmissions for COPD. COPD is the third most common diagnosis in 30-day readmissions. As of late 2014, CMS now issues a penalty on readmissions to hospitals, so there are widespread efforts by hospitals to develop solutions to reduce this readmission rate. Unfortunately, we have limited quantitative (validated) tools to assess the risk of readmission in our patients.
Some of the most important factors identified in this paper are the disengagement of many of our patients, as well as lack of education, inadequate health literacy, and lack of appropriate access and follow-up care.There is currently an ongoing PCORI funded PArTNER (Patient Navigator to Reduce Readmissions) study that is investigating the value of a community health practitioner who will visit patient 2-3 d post COPD discharge, and then continue with phone coaching for an additional 8 weeks post-hospitalization. Similar models with post-hospital outreach through care navigators have been shown to reduce re-hospitalization rate for COPD by almost 40%. While the model is good it brings the question about scaling to a larger population of COPD patients.
Could such a “human navigator” model be replaced by a “computer navigator” or virtual assistant on a phone device? This could serve the purpose of providing education for patients, as well as reminders on pill and inhaler adherence. Instructional links to videos could help patients with proper inhaler technique. Navigator could allow links to online community forums so that COPD patients could share their experience with others, which would also enhance the engagement of our patients. Patients seeking to stop smoking could also find encouragement from a virtual assistant.
Food for thought? I will be working with the Kencor design team to make the SAMi virtual assistant optimized for the patient engagement and remote patient monitoring. Ultimately we will need studies to show that these technologies can be similarly effective for our patients, as they are likely to be more cost effective and accessible on a mass scale.