Report: Tablet-Based App Curbs Readmissions for at-Risk Patients

August 6, 2014 in News

Health coaches who used tablet-based software to monitor the health of recently discharged, at-risk Medicare beneficiaries were better able to reduce readmission rates than health coaches who did not use the software, according to an Innovations Exchange report by the Agency for Healthcare Research and Quality, Becker’s Hospital Review‘s “Hospital CIO” reports (Jayanthi, “Hospital CIO,” Becker’s Hospital Review, 7/31).

Program Details

For the program, trained health coaches at Massachusetts-based Elder Services of Merrimack Valley visited medium- and high-risk patients within 48 hours of hospital discharge and followed up with patients via the telephone once a week for the next three weeks.

During each visit and phone call, coaches used a tablet-based application developed by Care At Hand to review patients’ diagnosis and treatment and to determine the patients’ risk profile.

If answers to the questions suggest a potential decline in health, the application will send a real-time alert to a nurse care coordinator, who will use a different component of the software to help the patient and coach address the problem within 24 hours.

Overall, coaches visited 561 patients over a six-month time period.

Program Results

Hospital-generated admissions data from participating hospitals show that incorporating the tablet-based application into the visitation program helped to:

  • Cut 30-day readmissions by 39.6% among at-risk patients eligible for the program, compared with a previous visitation program that did not use the software; 
  • Reduce all-cause readmissions for all Medicare beneficiaries, including those not assigned a coach, by 5.9%; and
  • Save roughly $109 per patient per month over a six-month period, with gross savings of about $600,000 and net savings of roughly $370,000 (Goth, Health Data Management, 8/6).
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