Wednesday, March 28, 2012

PapPap, the Talking Scale, and Readmissions

My PapPap and my son. October, 2010

Geisinger Health Plan recently reported that the use of interactive voice response and telemonitoring technologies facilitated a 44% reduction in hospital readmissions for patients with congestive heart failure, diabetes, and hypertension. This reduction was demonstrated in a clinical trial studying the technologies above versus the standard post-hospitalization follow-up. My PapPap happened to be a participant in the pilot group that led to this study. 

Upon discharge from the hospital, my PapPap was given a "talking scale" and instructed to plug it into the power socket and phone line (the pilot group was not wireless.) Each morning, he was to stand on it and have his weight measured. Each morning, the scale would capture his weight and ask him a series of standard questions about how he was feeling.

This led to a great deal of cursing.

Being the man he is, my grandfather attempted to have a conversation with the scale. He wasn't trying to be difficult... he was just being himself. Let me replay a typical exchange between my PapPap and the scale:

Scale: Are you short of breath?
PapPap: Naw, my breathing's fine.
Scale: Are you short of breath?
PapPap: I already told you my breathing's okay.
Scale: Are you short of breath?
PapPap: Bernice! This damn thing's not working!
Scale: Are you short of breath?
PapPap: Bernice! Call Elaine and tell her this idiot scale's not working again!
Scale: Are you short of breath?
PapPap: No! Now, how many times do I have to tell you?
Scale: Okay. Do you have any swelling?

This type of exchange happened fairly routinely until we explained to him that the scale only wanted yes and no answers. After several days, my PapPap and the scale came to an understanding. One day, his weight and responses were outside of the acceptable standards and he received a call from his nurse. He was instructed to make some changes to his medications.

This type of early and personalized response kept him and patients like him from needing to return to the hospital. Yet, it wasn't the scale that kept him out of the hospital. It was the way Geisinger Health Plan managed the knowledge about his condition.

Through the use of the talking scale, GHP collected standardized data at regular intervals to create information about PapPap's clinical course. That information was combined with algorithms to create knowledge about his clinical condition and generate clinical alerts that notified his providers about the change in his condition. These alerts represent actionable knowledge that allowed for early interventions to be performed and prevent further clinical decline in each patient.

While many are lauding the technologies used in this study, it was not the the Bluetooth, the interactive voice recognition software nor the talking scale that produced such dramatic improvements. It was the generation of individualized actionable knowledge for each participant that led to GHP's success and my PapPap's continued recovery.

Although, to hear him tell it, that damn idiot scale had nothing to do with it! 

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