Feb 05, 2019

Welcome to the White Space; the Most Important 30 Days of Your Life and How to Survive Them

Estimated reading time: 5-7 minutes

Gaps in anything tend to make us all nervous -- blank spaces on a page, breaks in conversation, the long wait to catch a flight. But if you’re a patient, gaps can be more than just unnerving, they can be downright dangerous. And one gap in particular can be lethal: the white space.

What is it? Imagine you’ve been hospitalized for shortness of breath. You’re diagnosed with Chronic Obstructive Pulmonary Disease (COPD), prescribed non-invasive ventilation and, before long, discharged. You return home, and suddenly switch from being the focus of attention of an entire care team to being totally invisible.

Welcome to the white space.

After being discharged from high-risk incident (COPD, pneumonia, heart failure, etc.), the first 30 days in the white space are statistically when you are most likely to relapse or even die. [1] Yet during that period you are often completely disconnected from healthcare oversight.

The white space has been on my mind more than ever. At a time when providers have fewer resources and more patients to care, and when more patients are suffering from chronic diseases, I wonder: how can connected solutions support care professionals to bridge the gap between the hospital and the home?

The first step for patients and providers is to shift mindset: to see care as a continuous journey.

The first – and arguably largest – hurdle to address if you’re a patient with any chronic disease is to find a provider who can see your care as a continuous thread. One of the biggest challenges for patients is the transition from hospital to home. In one study [2], where COPD patients shared their experiences caring for themselves during discharge and at home, results showed that they struggled to regain a sense of control and had trouble staying motivated and confident. Connected devices can help involve patients in their own care and make that transition easier.

Imagine you’re home with your non-invasive ventilator, oxygen and medication finding you’re struggling to stick to your prescription. Often the reason is a lack of encouragement or motivation, or simply finding the mask uncomfortable. This can then lead to a relapse and a return to hospital.

At Philips, we created a remote monitoring service that will notice that the system has not been used, prompting someone to call you to check in. They might schedule a home visit the next day to coach you on how to use your mask. That human contact – whether it’s from a home medical equipment provider (HME) or a respiratory therapist (RT) -- can make a big difference to readmission rates.

But stretched resources mean that not every patient can expect a home visit. This is where data comes into play.

Using data insights to bring care teams together

A recent initiative in Alabama showed that creating shared care pathways supported by data insights can have dramatic results. Philips was recently involved in a collaborative initiative to identify gaps in care and develop an integrated COPD program that incorporated continual data collection from hospital electronic medical records (EMRs), physician portals and RT notes from home visits. The connected approach gave the hospitals greater visibility into what was going on with patients at home after discharge, which proved critically important in identifying patients who were contributing to the problem before they had to be readmitted to the hospital.

From around 900 patients in the participating hospital group, this Integrated COPD Care Initiative achieved an 80% reduction in acute 30-day readmissions after just three fiscal quarters in 2017. [3] It cost less too – the initiative saved $1.3 million over the same time frame. [4]

The COPD Care Initiative achieved an 80% reduction in 3-day readmissions, focusing on improving 12 key factors.

Towards predictive care for at-risk patients

As our healthcare systems increasingly struggle to deliver better outcomes at lower cost, I see data insights bringing more support to care teams.

Using predictive analytics in particular, we’re starting to be able to identify when patients are at risk of becoming ill. In my previous blog, I looked at how our CareSage solution combines (mainly senior) patient demographics and medical condition data with Philips Lifeline medical alert service data to score a patient’s risk of transport to the hospital in an upcoming 30-day period.

We can do the same with respiratory patients. Gathering data from connected home ventilation devices enables us to create a daily risk score for healthcare providers that helps them to spot which patients are most in need and intervene earlier – ideally days before an exacerbation occurs.

Where do I think this could lead? In the future, I believe that connected care will support clinicians to uncover correlations and patterns in health information to provide predictive care for entire populations – for example, by spotting when groups of people in a certain city are likely to develop a disease. This could enable clinicians to take preventative action, save unnecessary costs (something I will tackle in my next blog), and reduce health risk.

To say I’m excited by the possibilities of how connected solutions will support patients in the future is an understatement. I look forward to continuing the conversation around how we can support healthcare professionals in understanding patients better, and how we can motivate patients to become active participants in their own health, so that the white space becomes well and truly a thing of the past.

[1] https://www.bmj.com/content/350/bmj.h411

[2] Ingrid Charlotte Andersen, Thora Grothe Thomsen, Poul Bruun, Uffe Bødtger & Lise Hounsgaard (2017) The experience of being a participant in one’s own care at discharge and at home, following a severe acute exacerbation in chronic obstructive pulmonary disease: a longitudinal study, International Journal of Qualitative Studies on Health and Well-being, 12:1,

[3] Alabama Hospital 2017 COPD Care Management initiative. Author Incremedical using Medadept information technology. Solely funded by Philips.

[4] Alabama Hospital 2017 COPD Care Management initiative. Author Incremedical using Medadept information technology. Solely funded by Philips.