I. E. McElroy1, A. Zhu1, G. Miranda1, H. Wu1, M. Nguyen1, R. Shemin1, P. Benharash1 1University Of California – Los Angeles,Department Of Cardiac Surgery,Los Angeles, CA, USA
Introduction:
Unintended rehospitalizations after surgical procedures represent a large percentage of readmissions and have been associated with increased morbidity and cost of care. Beginning in 2017, Medicare will enforce provisions that subject hospitals to financial penalties for excess postoperative readmissions. Rehospitalizations following cardiac operations have been linked to rhythm disturbances and pulmonary complications, amongst others. Technologic advances in remote monitoring have led to the use of web-based digital health kits (DHK) aimed at reducing readmissions and improving postoperative outcomes. The present study was performed to determine DHK’s efficacy in preventing 30-day readmissions and changes in patient satisfaction following the use of these devices.
Methods:
This was a prospective study of all adult patients who underwent operations for valvular and coronary artery disease at our institution from 03/2014 to 06/2015. During the study period, 558 adult patients (Mean age: 64± 14, 33% female) were identified, 27 of whom received a DHK following discharge (531 control group). In addition to providing a live video link with a provider specializing in cardiac surgery, the kit allowed for automatic daily transmission of weight, oxygen saturation, heart rate and blood pressure. Patients also completed a daily health survey targeting heart failure symptoms, wound healing, ambulation and adherence to medications. Abnormal vitals or survey responses triggered automatic notifications to the healthcare team. Satisfaction surveys were administered to participants and members of the healthcare team (Scale 1-5, 5=highly-satisfied). Pearson’s chi-squared and student’s t-tests were used to assess statistical differences in baseline characteristics and outcome variables (STATA 13).
Results:
During the study period, use of DHK led to 1734 alerts and 138 interventions. The readmission rate for the DHK group was lower than the control group (7.4% vs. 10.9%, P=0.57). Reasons for readmission in the DHK group were amiodarone toxicity and syncope. Reasons for readmission in the control group included arrhythmias, heart failure, pericardial effusion, acute vascular complication, infection, and respiratory complications. Satisfaction surveys showed an overall satisfaction rating of 4.9 (± 0.53) for DHK patients and 4.9 (±0.20) for members of the care team.
Conclusion:
In our study, utilization of DHKs was associated with a non-significant decrease in 30-day readmission rates. Both patients and members of the healthcare team were highly satisfied with this technology. DHKs appear to extend care beyond the inpatient period and may provide much needed monitoring of surgical patients after discharge. However, their use leads to many provider alerts and interventions, making this modality resource-intensive. Further studies are warranted to evaluate the efficacy of such kits in reducing readmissions and costs of care.