Patients key to reducing readmissions

There have been many ideas proposed as solutions for reducing costly hospital readmissions, but one concept that hasn’t gotten much attention over the years is patient empowerment – the practice of letting people take control of their healthcare.

The proliferation of mobile devices and continued advancements in communications technology make accessibility to clinicians, health information and personal records easier than ever, and backed by evidence-based research, the time is ideal for this new model to emerge and succeed, say executives at Raleigh, N.C.-based Axial Exchange.

[See also: Patient engagement lessons]

“Looking ahead five years, we will change how healthcare operates,” Axial CEO Joanne Rohde states confidently. “Where we really differentiate ourselves is by having the things that we as patients want, along with a two-way learning process in measuring how we’re doing it.”

Rohde has a deep empathy with patients and traces her desire for redesigning healthcare delivery to her own experience as a fibromyalgia sufferer. Six years ago Rohde began an unpleasant odyssey through the inefficiencies of the healthcare system trying to determine the cause of debilitating headaches and body pain.

“I went from one specialist to another and couldn’t get a diagnosis,” she said. “No one knew what it was. It took a long time before I found a doctor who identified it. I thought to myself that when I get well I’m going to do something about this.”

In founding Axial in 2009, Rohde said she applied her experience as a frustrated patient to her business background in order to devise a company that could facilitate “the idea of everyone winning” with healthcare delivery. Until then, “that had been hard to do,” she said. “We looked into the technical part and realized that the behind-the-scenes issue was the inability to share clinical information from a variety of sources.”

[See also: Low patient activation scores linked to higher costs]

Even more importantly, she said, they concluded “the only way to bend the cost curve and get better outcomes was to involve patients in their own care more deeply and share their information with providers in a way that is meaningful and timely – that is how it was born.”

Linked with Mayo

With a software pedigree from an enterprise called Red Hat, Rohde and her team launched Axial with the intent to develop mobile patient applications.

“Our first chapter was to build out an interoperability infrastructure for records to be accessed from any system,” said Matt Mattox, vice president of products. “We introduced it into Children’s Hospital in Raleigh and then to a unit of HCA in Colorado.”

In June 2012, Axial won the Office of the National Coordinator’s Developer Challenge on "Ensuring Safe Transitions from Hospital to Home," a competition sponsored by the Partnership for Patients Initiative. Publicity from the honor led to a financial relationship with the Mayo Clinic.

“They invested and joined our clinical advisory board,” Mattox said. “That is when we got started focusing on extending the capability of the product. The app can be mobile, but there is also a provider-facing dashboard so they can see what patients are doing.”

Over the past two years, Axial has grown to include 10 health system clients representing 50 hospitals.

BOOSTed by research

The patient empowerment approach is supported by two recent research initiatives – Project BOOST (Better Outcomes for Older adults through Safe Transitions) and Project RED (Re-Engineered Discharge).

Project BOOST is an initiative of the Society of Hospital Medicine, focused on improving the care of patients as they transfer from hospital to home. It is led by a national advisory panel of recognized leaders in care transitions, hospital medicine, payers and regulatory agencies, and aims to improve hospital discharge processes.

Among its objectives are to reduce 30-day readmission rates, improve patient satisfaction scores, open the flow of information between providers and patients, increase family caregiver involvement and identify patients at high risk for readmissions.

Project RED is an evidenced-based approach to improving the discharge process so that patients are well prepared to leave the hospital. It was originally developed in 2006 at Boston University Medical Center.

Its checklist is designed to help the hospital staff remember to hit all of the key elements of the program with each patient, including educating patients about their status throughout their hospital stay, make appointments for clinician follow-up and post-discharge testing and emphasize the importance of regular clinician appointments.

Beyond transactions

Rohde’s confidence in the patient-based health management approach is that “it resonates with patients and providers.” For patients, the value comes from “taking care of your own health, letting in family members and sharing information with physicians inside and outside of the hospital, wherever they are.”

To be sure, heavy provider investment in electronic health records is necessary, Rohde concedes, but she also contends that “despite spending huge sums of money on EHRs, the healthcare delivery model is in insufficient condition.”

It is almost as if the industry has it backwards by installing the technology before redesigning the delivery model, she said.

“We need to go beyond transactions,” Rohde said. “We need to include behavior, engagement and education. This is what has to change and if it does, the technology will follow.”