At Penn Medicine, 29% of cirrhosis patients and 32% of patients who have a liver transplant are readmitted within 30 days of discharge. Together, the readmissions for these populations lead to more than $21 million in costs each year.
Readmissions are inconvenient and dangerous for patients, as morbidity and mortality risk is increased in the hospital, and cirrhotic patients who are readmitted are less likely to survive until transplant.
In 2015, a team led by Vandana Khungar, MD, piloted a wireless mobile device monitoring system using a tablet provided to patients to detect early signs and symptoms. The system reduced readmission rates from 28% to 13% in a group of 21 patients over the course of a year.
However, due to the high cost of the intervention and considerable use of physician time, the solution was not scalable.
In partnership with Khungar, we set out to refine the original intervention so that it could be scaled to all patients.
We ran nine pilots over six months. Changes included introducing lower-cost technology by having patients use their cell phones to report symptoms rather than tablets, leveraging the Way to Health platform to automate messages to patients, and implementing a leaner staffing model that relied primarily on patient liaison and RN oversight - only escalating to a physician when necessary.
The changes implemented during the pilot period led to a sizable reduction in cost, from $1019 to $50 per patient. And whereas the original intervention was 100% powered by RN and MD time, the new staffing model resulted in only 4% of cases being escalated to an MD or PA.
Most importantly, the refined intervention resulted in a 43% reduction in 30-day readmissions among the pilot population. At scale, these results are projected to lead to a $6.8 million reduction in costs related to cirrhosis 30-day readmission costs, and a $2.2 million reduction in costs for 30-day liver transplant readmissions annually.
The team aims to test this intervention further in a year-long pragmatic trial before making this the standard of care at Penn Medicine.