The Problem
Readmission rates for heart failure (HF) and chronic obstructive pulmonary disease (COPD) remain high. Heart failure and COPD represent significant burdens to patients, providers, and payers. Heart failure is the leading cause of hospital readmission among older patients in the United States. Hospitals have responded to these incentives by developing strategies to reduce readmission rates such as early physician follow-up within 7 days of discharge. Despite implementation of strategies to reduce readmissions after a hospitalization for HF, 30-day readmission rates remain at 20- 25%, and the 1-year mortality rate after a HF hospitalization remains unchanged at 20-25%. No intervention has been proven to improve rates of COPD readmissions.
Our Solution
The proposed solution was to equip patients admitted with COPD or CHF with a step counter and configure their iOS devices to transmit their daily step counts to Epic. In parallel the team administered a brief daily survey of symptoms to complement the step count information. This capability could potentially be built into a MyChart survey following a successful pilot. The team hoped to demonstrate feasibility of such a care pathway, reliable transmission of data, acceptability to patients and providers, and begin to understand if this data could be useful for identifying readmission risk.
Impact
Patients generally used smartphones (approximately 85% of patients screened), mirroring national trends (see pew internet survey and others), however these were overwhelmingly Android devices (approximately 90%). This also reflected national trends at the time; iOS had a 85% patients generally use smart phones 90% phones were Android devices minority of the market in the US, and Android phones are favored by the less economically advantaged. Internationally, Android had >80% of the smartphone market.
