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Home Video Conferencing Technology Helps Prevent Patient Readmissions
Video conferencing with mobile devices can significantly reduce unnecessary hospital readmissions. In a recent study conducted in Central Indiana, a randomized group of chronically ill patients who kept in contact with nurses via video conferencing technology for 30 days post-discharge had a hospital readmission rate of 5%, versus the national average of 21%.
Preliminary results of the ongoing study are quite promising, notes principal investigator Alan Snell, MD, MMM, chief medical informatics officer for St. Vincent Health & Indiana Health Information Exchange, a statewide health system with 22 acute-care facilities and numerous practice sites. Patients in the study used a device known as a Health Guide, and Bluetooth technology, for in-home health monitoring purposes.
“Our goal was to use the technology in the home to remotely monitor these patients and apply principles of ear ly inter vention to keep them from being readmit ted,” Dr. Snell says. “We were confident the study would be successful, but were pleasantly surprised with the current 80% reduction in readmits.”
The randomized trial initially focused on 308 patients from 14 hospitals in Indiana with a diagnosis of either congestive heart failure (CHF) or chronic obstructive pulmonary disease (COPD). Known as the Readmission Reduction Research Study, it was funded by a grant from the Central Indiana Beacon Community in Indianapolis, Indiana. The study is a 3-year-long, $16 million federally supported ef for t designed to s treng then health information technolog y infrastructure and test innovative approaches to improve healthcare services, patient care, and hospital costs.
Devices such as the Health Guide allow recently discharged patients to keep in contact with hospital nurses from home.
A major impetus for the trial was the new Centers for Medicare & Medicaid Services (CMS) requirement— which went into effect in October 2012—that penalizes hospitals for their readmission rates, Dr. Snell notes. He and his colleagues were particularly interested in how interventions during the first 30 days of hospital discharge could help prevent people from returning to the hospital.
For the study, patients were separated into an intervention or control group. The control group received the standard discharge information, while the intervention group left the hospital with the Health Guide device, enabling them to chat with a nurse up to 6 times by video conference over the next 30 days. Patients in the intervention group also took daily measurements using a Bluetooth-enabled scale and pulse oximeter as well as a blood pressure cufftethered to the device. All of this information was sent to the nurse.
Additionally, patients in the intervention group used the device's touch screen to answer 6 questions daily. The Health Guid e a ls o co nt ains 17 e duc at ional v ideos on t opic s rang ing from diabetes and diet to exercise and general health.
“Toward the end of 2011, it was apparent that the clinical randomized, controlled trial was only going to enroll so many patients, so we decided to create a second arm,” Dr. Snell says. “We decided to find the patients who were the sickest, and who had the most [hospital] admissions, emergency department visits, and histories of high utilization.”
The second round included more than 100 of the sickest patients, and they too experienced a significant reduction in readmissions within 30 days of discharge after using the home health monitoring devices. Dr. Snell points to one patient in particular, a woman in her 50s with CHF, who had 13 hospital admissions in 2011, resulting in $156,000 in inpatient and outpatient costs.
The woman's home health agency had essentially given up on her because she wouldn't go to doctor's appointment s or take her medication proper ly. However, since she began using the Health Guide home monitoring program in December 2011, she has not been admitted to the hospital, and incurred healthcare charges of only $1,500 through mid-August of 2012, Dr. Snell says. With encouragement from her monitoring nurses, she has been highly compliant with her medical regimen and maintained scheduled physician appointments, according to Dr. Snell.
“She loves the monitoring program,” he says, adding that she and others appreciate that the program does not involve any invasion of privacy. “She liked the ability to connect with a nurse without having someone come into her home.”
Upon completion of the study, Dr. Snell and colleagues plan to explore ways to use the technology to help patients monitor and understand their chronic diseases.
Universitv of Texas Students Train for Translational Science Careers
Julieta Scalo studied philosophy in college and spent many years as a human resources director before earning her doctorate of pharmacy degree at the University of Texas at Austin. Kelly Daniels, who earned the same degree, had always planned on becoming a community pharmacist.
But their research interests took them elsewhere, and now both are part of the first class of 6 students who will be earning doctorates through the new University of Texas (UT) Translational Science PhD program. The program is jointly offered through the UT at Austin College of Pharmacy, UT at San Antonio (UTSA), and the UT Health Science Center at San Antonio. It draws on the expertise and resources of each university to offer training that will enable graduates to lead multidisciplinary biomedical research teams in increasingly complex research environments. The UT School of Public Health, San Antonio Regional Campus, is also a partner in the effort, but does not offer the degree.
“Translational science appealed to me because of the ability to fold in different disciplines to work collaboratively” Scalo says. Adds Daniels, “We're able to pick and choose among different experts who can help mentor you and mold you into what you want to be.”
The program is one of about 20 translational science PhD programs across the nation that have sprung up as a result of the National Institutes of Healths growing emphasis on translational research. Christopher Frei, PharmD, MsC, and a faculty member at the UT of Austin College of Pharmacy, says the program will help develop scientists who can translate basic biomedical scientific discoveries to help patients and improve communities’ overall health.
Julieta Scalo (l.) and Kelly Daniels are among the first class of students to pursue their doctorate degrees through the University of Texas’ new translational science PhD program.
The areas of study include basic discovery, clinical research, health services, epidemiology, community-based participatory research, and health policy research. Students are required to take at least one course, or more, at each participating institution.
Scalo says many other translationa science PhD programs focus on ; particular area, such as biomedica engineering or bioinformatics, while the University of Texas program is a true collaboration among 4 differen institutions.
“It's a model for how we'll hav to conduct business and science in the future,” she says. “And it allows u to take advantage of the strengths o each institution, with UT Austin doinj a lot of bench science, and UT San Antonio's strength in clinical science.” Scalo's interests include oncology and assisting cancer patients with sleep problems. Daniels, meanwhile, is interested in developing technologies to help prevent healthcare-associated infections, such as pneumonia and other life-threatening conditions.
“We have these discoveries, and a lot of them haven't been implemented in patient care yet,” Daniels says. “My goal would be to develop an interdisciplinary team to work with physicians, nurses, administrators, and policymakers to study, prevent, and treat these infections.”
Presidential Advisory Panel's Report Urges Doubling Output of Innovative Medicines
In a report issued last fall, the President's Council of Advisors on Science and Technology (PCAST) emphasizes the importance of doubling the output of nnovative new medicines that meet critical health needs over the next 10 to 15 years, while simultaneously improving drug safety.
The report, “Propelling Innovation in Drug Discovery, Development, and Evaluation,” assesses the inability of the drug development ecosystem to translate major scientific advances into practical solutions and makes a number of recommendations.
“There are a bunch of different trends that all combine to be real barriers to nnovation of new drugs, as well as a decline in the success rate of new drugs and nnovations coming out of the pipeline,” says PCAST member Christine Cassel, MD, president and chief executive officer of the American Board of Internal Medicine in Philadelphia, Pennsylvania. “One of the reasons is the inability of industry itself to come together and identify the major paths and targets that are the most useful.” Among the report's recommendations are:
- Supporting federal initiatives to accelerate therapeutics
- Catalyzing the creation of a broad-based partnership to accelerate therapeutics
- Expanding the use in practice of the Food and Drug Administration (FDA)'s existing authorities for accelerated approval for confirmatory evidence
- Creating a new pathway for initial approval of drugs shown to be safe and effective in a specific subgroup of patients
- Improving FDA's tools for monitoring and communication of clinical benefits and risks Studying current and potential economic incentives to promote innovation in drug development
The report's authors note that many common cancers are incurable unless they are caught early, and most rare diseases lack effective therapies. At the same time, nfectious diseases continue to pose a large-scale mortality threat, while treatments for psychiatric diseases and neurodegenerative diseases are highly limited.
A federal report calls for a partnership between public and private sectors to help bring life-saving drugs to market.
“There are some very serious and debilitating diseases for which we don't have any drugs, and the report was trying to look at each of the pieces along the drug development pathway to figure out what government and the private sector can do to try to make sure that unmet health needs are addressed over the next 10 to 15 years,” says PCAST acting executive director Amber Hartman Scholz, PhD.
The 3 main components of the drug development system—basic biomedical research in universities and institutes, clinical research in hospitals, and drug discovery in the biopharmaceutical industry—each face challenges as the complexity and cost of the process increases, according to the report. The authors point out that 2 critical needs must be addressed:
- Scientists need better methodologies and tools to translate basic insights into validated therapeutic targets and leads. This gap in the pipeline is sometimes viewed as “too applied” by academic scientists and “too basic” to justify private nvestment by pharmaceutical companies.
- The FDA and drug developers need to bring new efficiencies to drug clinical trials, which are extremely costly and complex. They cite 2 studies, the “Investigation of Serial Studies to Predict Your Therapeutic Response with Imaging And Molecular Analysis 1 and 2” (I-SPY 1 and I-SPY 2), as examples of ongoing trials that can efficiently evaluate different breast cancer therapy regimens without having to recruit new patients each time.
To achieve these goals, PCAST recommends the creation of a public-private partnership that would include representatives from the biopharmaceutical ndustry, the academic biomedical research and ethics community, physician societies and pharmacists, patient-focused research foundations and advocacy groups, health insurers and providers, and the federal government.
“The partnership would enable each group to exchange what they're doing and coordinate with one another to identify problems and prioritize activities,” Dr. Scholz says.
Matthew Bennett, senior vice president of the Pharmaceutical Researchers and Manufacturers Association of America (PhRMA) in Washington, D.C., believes the public-private partnership that PCAST proposes is a promising concept, but that details for its goals and mission need to be worked out.
“PhRMA welcomes the opportunity to work with PCAST and other members of the innovation ecosystem to further explore the issues raised in the report, including defining the specifics of the proposed new public-private partnership,” Mr. Bennett says.
The report also recommends that the Department of Health and Human Services commission a study that will explore incentives to encourage companies to invest in drug development for certain types of diseases—such as rare ones— that may not appear to be lucrative. One example is the pressing need for new antibiotics, even though the market share is small, Dr. Cassel says.
Though many challenges remain, PCAST members still see some hope, citing the fact that the FDA approved 35 new medicines in the past year—one of the largest amounts approved within the past decade.
Federal Program Helps Patients Make Smart Healthcare Choices
When the Patient-Centered Outcomes Research Institute (PCORI) was authorized by Co ngre ss as par t of the Pat ient Protection and Affordable Care Act of 2010, its mission was to conduct research to help patients and their clinicians make better informed healthcare decisions.
Since that time, PCORI leaders have worked toward that goal through a variety of efforts, including grant opportunities and engagement work shops with key stakeholders.
“We have a very distinct purpose compared to any other funding organization, and that is to focus just on decision making by patients,” says PCORI executive director Joe Selby, MD, MPH. “We don't focus on the causes or biologic mechanisms of disease.”
PCORI's main focus is enabling patients to compare outcomes of prevention, treatment, and healthcare options, and engage them and other key stakeholders in helping develop research questions, shape the research, and disseminate results, he notes. Toward that end, PCORI spent 9 months gathering input from patient and physician organizations to identif y 5 research priorit y areas, which were announced in May 2012:
- Assessing the benefit, and harm, of prevention, diagnosis, and treatment options (comparing the effectiveness and safety of different options)
- Improving healthcare systems (comparing systems to improve access, care, health information technology, and workforce deployment)
- Communicating and disseminating research
- Addressing disparities
- Accelerating patient-centered outcomes research and methodological research (improving infrastructure, analytic methods, and training)
At press time, PCORI officials were reviewing proposals addressing the first 4 of these priorities, and were preparing to announce $96 million in grants by the end of 2012. PCORI is supported by a combination of government funds and a small fee assessed on Medicare, private health insurance, and self-insured plans. In addition, they plan to issue a request for proposals to accelerate research into patient-centered outcomes, as well as more targeted funding announcements.
The Patient Centered Outcomes Research Institute (PCORI) is a federally funded program designed to help patients make informed decisions about healthcare.
Last May, PCORI announced the funding of 50, 2-year pilot projects that address ways to engage patients in every area of research and improve methodologies. Moreover, PCORI hosted 3 workshops last fall to hear directly from patients, clinicians, caregivers, researchers, policymakers, and insurers on key research questions and efforts, and to forge future collaborations.