The Impact of an Automated Patient Digital Engagement Application on Revisit Reduction (Preprint)

2020 ◽  
Author(s):  
Pothik Chatterjee ◽  
Adam Michael Beck ◽  
Jenna Ashley Levenson Brager ◽  
Daniel James Durand
Keyword(s):  
Health System ◽  
Patient Engagement ◽  
Information Exchange ◽  
Digital Health ◽  
General Medicine ◽  
Inpatient Setting ◽  
Hospital Inpatient ◽  
Digital Engagement ◽  
The Impact ◽  
Improve Patient

BACKGROUND Revisits within 30-days to an emergency department (ED), observation care unit, or inpatient setting following patient discharge continue to be a challenge, especially in urban settings. In addition to the consequences for the patient, these revisits have a negative impact on a health system’s finances in a value based care or global budget environment. LifeBridge Health, a community health system in Maryland, implemented an automated patient digital engagement application as part of the overall organization’s digital health strategy to improve patient engagement and reduce revisits to the ED. OBJECTIVE To evaluate the effectiveness of a customized automated digital patient engagement application (GetWell Loop) to reduce 30-day revisits after home discharge from an ED or hospital inpatient setting. METHODS The LifeBridge Health Innovation Department and ED staff from two participating health system hospitals collaborated with the GetWell Network to customize their patient engagement application (GetWell Loop) with automated check-in questions and resources. An application link was e-mailed to adult patients discharged home from the ED. A retrospective study of ED visits for patients treated for general medicine and cardiology conditions between 8/1/2018 through 7/31/2019 was conducted using CRISP, Maryland’s state-designated health information exchange. We also used data within GetWell Loop to track patient activation and engagement. The primary endpoint was a comparison of ED patients that experienced a 30-day revisit and who did or did not activate their GetWell Loop account. Secondary end points included overall activation rate and the rate of engagement as measured by the number of logins, alerts, and comments generated by patients through the application. Statistical significance was calculated using the Fisher’s exact test with a P-value < 0.05. RESULTS Patients discharged from the ED who were treated for general medicine conditions (n=2087) and activated their GetWell Loop account experienced a 30-day revisit rate of 17.3% compared to 24.6% who did not activate their account (P<.001). For patients treated for cardiology conditions (n = 1779), 12.8% of patients who activated their GetWell account experienced a 30-day revisit compared to 17.7% not activating their account (P=.01). During this one-year study, 25% of all emergency patients receiving an invite to use the digital application activated their account (n=4125), logged in a total of 8935 times, generated 1911 alerts, and submitted 771 open ended comments/questions. CONCLUSIONS These results indicate the potential value of digital health applications to reduce 30-day revisit rates. The results also indicate patients are willing to utilize a digital application post-discharge to proactively engage in their own care. LifeBridge Health’s experience demonstrates that healthcare systems can leverage automated mobile applications to improve patient engagement and successfully impact clinical outcomes at scale.

scholarly journals The Impact of an Automated Patient Digital Engagement Platform on Revisit Reduction

Iproceedings ◽  
10.2196/15091 ◽  
2019 ◽  
Vol 5 (1) ◽  
pp. e15091
Author(s):  
Adam Beck ◽  
Caroline Robinson
Keyword(s):  
Emergency Department ◽  
Patient Engagement ◽  
Information Exchange ◽  
Negative Impact ◽  
Statistical Significance ◽  
General Medicine ◽  
Inpatient Setting ◽  
Hospital Inpatient ◽  
Digital Platform ◽  
The Impact

Background Revisits within 30 days to an emergency department (ED), observation care unit, or inpatient setting following patient discharge continues to be a challenge, especially in urban settings. In addition to the consequences for the patient, these revisits have a negative impact on a health system’s finances in a value based care or global budget environment. Objective The objective was to evaluate the effectiveness of a customized automated digital patient engagement application (GetWell Loop) to prevent 30-day revisits after home discharge from an ED or hospital inpatient setting. Methods The LifeBridge Health Innovation Team collaborated with the GetWell Network to customize their patient engagement platform (GetWell Loop) with automated check-in questions and resources. An application link was emailed to adult patients discharged home from the ED. A retrospective study of ED visits for patients treated for general medicine and cardiology conditions (accounting for 24% of our adult ED discharges) between August 1, 2018, and December 31, 2018, was conducted using CRISP, Maryland’s state-designated health information exchange. We used this database to identify the index visits that experienced an emergency department visit, inpatient admission, or observation stay at any Maryland facility within 30 days of discharge. We also used data within GetWell Loop to track patient activation and engagement. The primary endpoint was a comparison of ED patients that experienced a 30-day revisit and who did or did not activate their GetWell Loop account. Secondary end points included overall activation rate and the rate of engagement as measured by the number of logins, alerts, and comments generated by patients through the platform. Statistical significance was calculated using the Fisher’s exact test with a P<.05. Results ED discharges who were treated for general medicine conditions (n=787) and activated their GetWell Loop account experienced a 30-day revisit rate of 18.9% compared to 25.2% who did not activate their account (P=.06). For patients treated for cardiology conditions (n=722), 10.5% of patients who activated their GetWell account experienced a 30-day revisit compared to 17.4% not activating their account (P=.02). During the course of this study, 26% of patients receiving an invite to use the digital platform activated their account (n=1652) logged in a total of 4006 times, generated 734 alerts, and submitted 297 open ended comments/questions. Conclusions These results indicate the potential value of digital health platforms to improve 30-day revisit rates. The strongest impact was observed amongst cardiology patients where the revisit rate is 39.8% lower for patients using GetWell Loop compared to general medicine patients where the relative difference is 25.2%. The results also indicate patients are willing to utilize a digital platform postdischarge to proactively engage in their own care. We attempted to control for potential selection bias that may impact this analysis given patient adoption and use of a digital platform by looking for differences in the subpopulations who did and did not activate the platform. LifeBridge Health is proving healthcare systems can leverage automated mobile platforms to successfully impact clinical outcomes at scale without compromising customer service and patient experience.

scholarly journals Impact of electronic personal health record use on engagement and intermediate health outcomes among cardiac patients: a quasi-experimental study

2016 ◽  
Vol 23 (1) ◽  
pp. 119-128 ◽  
Author(s):  
Tammy Toscos ◽  
Carly Daley ◽  
Lisa Heral ◽  
Riddhi Doshi ◽  
Yu-Chieh Chen ◽  
...  
Keyword(s):  
Body Mass Index ◽  
Health Outcomes ◽  
Body Mass ◽  
Patient Engagement ◽  
Information Exchange ◽  
Personal Health Record ◽  
Personal Health ◽  
Health Record ◽  
Quasi Experimental ◽  
The Impact

Abstract Objectives To determine the impact of tethered personal health record (PHR) use on patient engagement and intermediate health outcomes among patients with coronary artery disease (CAD). Methods Adult CAD patients ( N = 200) were enrolled in this prospective, quasi-experimental observational study. Each patient received a PHR account and training on its use. PHRs were populated with information from patient electronic medical records, hosted by a Health Information Exchange. Intermediate health outcomes including blood pressure, body mass index, and hemoglobin A1c (HbA1c) were evaluated through electronic medical record review or laboratory tests. Trends in patient activation measure® (PAM) were determined through three surveys conducted at baseline, 6 and 12 months. Frequency of PHR use data was collected and used to classify participants into groups for analysis: Low , Active , and Super users. Results There was no statistically significant improvement in patient engagement as measured by PAM scores during the study period. HbA1c levels improved significantly in the Active and Super user groups at 6 months; however, no other health outcome measures improved significantly. Higher PAM scores were associated with lower body mass index and lower HbA1c, but there was no association between changes in PAM scores and changes in health outcomes. Use of the PHR health diary increased significantly following PHR education offered at the 6-month study visit and an elective group refresher course. Conclusions The study findings show that PHR use had minimal impact on intermediate health outcomes and no significant impact on patient engagement among CAD patients.

scholarly journals Facilitating Organizational Change to Accommodate an Inpatient Portal

2019 ◽  
Vol 10 (05) ◽  
pp. 898-908
Author(s):  
Daniel M. Walker ◽  
Alice Gaughan ◽  
Naleef Fareed ◽  
Susan Moffatt-Bruce ◽  
Ann Scheck McAlearney
Keyword(s):  
Medical Center ◽  
Academic Medical Center ◽  
Shared Responsibility ◽  
Care Team ◽  
Inpatient Setting ◽  
Successful Implementation ◽  
Hospital Inpatient ◽  
Team Members ◽  
The Impact ◽  
Over Time

Abstract Background Patient portals are becoming more commonly used in the hospital inpatient setting. While the potential benefits of inpatient portals are acknowledged, there is a need for research that examines the challenges of portal implementation and the development of best practice approaches for successful implementation. Objective We conducted this study to improve our understanding of the impact of the implementation of an inpatient portal on care team members in the context of a large academic medical center. Our study focused on the perspectives of nursing care team members about the inpatient portal. Methods We interviewed care team members (n = 437) in four phases throughout the 2 years following implementation of an inpatient portal to learn about their ongoing perspectives regarding the inpatient portal and its impact on the organization. Results The perspectives of care team members demonstrated a change in acceptance of the inpatient portal over time in terms of buy-in, positive workflow changes, and acknowledged benefits of the portal for both care team members and patients. There were also changes over time in perspectives of the care team in regards to (1) challenges with new technology, (2) impact of the portal on workflow, and (3) buy-in. Six strategies were identified as important for implementation success: (1) convene a stakeholder group, (2) offer continual portal training, (3) encourage shared responsibility, (4) identify champions, (5) provide provisioning feedback, and (6) support patient use. Conclusion Inpatient portals are recognized as an important tool for both patients and care team members, but the implementation of such a technology can create challenges. Given the perspectives care team members had about the impact of the inpatient portal, our findings suggest implementation requires attention to organizational changes that are needed to accommodate the tool and the development of strategies that can address challenges associated with the portal.

scholarly journals Electronic Medical Records in the American Health System: challenges and lessons learned

2020 ◽  
Vol 25 (4) ◽  
pp. 1293-1304 ◽  
Author(s):  
Robert S. Janett ◽  
Peter Pano Yeracaris
Keyword(s):  
Health Care ◽  
Patient Care ◽  
Electronic Medical Records ◽  
Medical Records ◽  
Information Exchange ◽  
Improve Patient Care ◽  
Lessons Learned ◽  
Disruptive Technology ◽  
The Impact ◽  
Improve Patient

Abstract Electronic medical records have been touted as a solution to many of the shortcomings of health care systems. The aim of this essay is to review pertinent literature and present examples and recommendations from several decades of experience in the use of medical records in primary health care, in ways that can help primary care doctors to organize their work processes to improve patient care. Considerable problems have been noted to result from a lack of interoperability and standardization of interfaces among these systems, impairing the effective collaboration and information exchange in the care of complex patients. It is extremely important that regional and national health policies be established to assure standardization and interoperability of systems. Lack of interoperability contributes to the fragmentation of the information environment. The electronic medical record (EMR) is a disruptive technology that can revolutionize the way we care for patients. The EMR has been shown to improve quality and reliability in the delivery of healthcare services when appropriately implemented. Careful attention to the impact of the EMR on clinical workflows, in order to take full advantage of the potential of the EMR to improve patient care, is the key lesson from our experience in the deployment and use of these systems.

scholarly journals Study of cross-referrals to the dermatology department in an inpatient setting at a tertiary care centre

2020 ◽  
Vol 8 (2) ◽  
pp. 647
Author(s):  
Niyati Bakhtar ◽  
Kirit Pandey ◽  
Neha Pandey ◽  
Nikhil Bakhtar ◽  
Vijay Bakhtar
Keyword(s):  
Descriptive Analysis ◽  
Tertiary Care ◽  
General Medicine ◽  
Skin Lesions ◽  
Cross Sectional Study ◽  
Inpatient Setting ◽  
Tertiary Care Centre ◽  
Cross Sectional ◽  
Dermatology Department ◽  
The Impact

Background: Till recently, dermatology was primarily being considered to be an outpatient focused discipline. However, several inpatient admissions to other specialties require dermatologic consultation for optimum management. This study was conducted to analyse the incidence and indications for inpatient dermatology referrals and the impact of dermatology consultation on patient management.Methods: A cross-sectional study was undertaken by analyzing the records of 243 patients referred to dermatology department over a 2-year period. Descriptive analysis was conducted in the form of study of presumptive diagnoses by the referring clinicians, causes of referral, distribution of referrals across specialties and the dermatological opinions with respect to diagnosis and management etc.Results: Clinically significant change was documented in the course of skin lesions management of almost two-thirds of referred patients. Maximum referrals were from the department of general medicine with “skin rash” being the most common cause for seeking 2nd opinion. Concordance for diagnosis between the referring clinician and the dermatologist was observed in only 30.2% of the cases.Conclusions: Dermatologic referral does lead to improved patient care. But there is need for better training of non-dermatologists enabling them to recognize and treat common skin lesions.

Digital engagement preferences of individuals aged 65 and older with cancer.

2020 ◽  
Vol 38 (29_suppl) ◽  
pp. 289-289
Author(s):  
Matthew Allison ◽  
Jonathan Patterson ◽  
Stephen Burton ◽  
Dhiren Patel ◽  
Kelly Jean Brassil
Keyword(s):  
Older Adults ◽  
Patient Engagement ◽  
Digital Health ◽  
Text Message ◽  
Geriatric Oncology ◽  
Patient Characteristics ◽  
Demographic Differences ◽  
Chi Square ◽  
Facilitators And Barriers ◽  
Digital Engagement

289 Background: Recent reviews suggest that digital solutions play a prominent role in the context of geriatric oncology. While interventions ranging from remote monitoring to nutrition and physical activity support have demonstrated feasibility in older adults (aged 65 and older), little is known about facilitators and barriers to eHealth uptake in older adults diagnosed with cancer. Insights into the digital engagement preferences of older adults with cancer may help to inform which platforms may be best aligned to optimal engagement and outcomes. Methods: A retrospective analysis was conducted to examine patient engagement preferences (phone, text and/or email) among older adults with cancer enrolled in a digital health coaching program. Descriptive statistics were used to summarize patient characteristics. Chi-square tests were used to evaluate differences in patient engagement preferences by race. Results: Of 513 individuals, the majority (n = 308; 60%) preferred information be provided by phone, email and text, while 20% (n = 105) requested content by phone and text only. Less than 10% of the sample requested content via phone only (n = 45; 8%), phone and email, (n = 31; 6%), email only (n = 11, 2%), or by email and text (n = 9; 2%). Interestingly, adults aged 65 and older had a significant predisposition to phone only communication (8.77%) compared to 2.25% in the general oncology population (p < 0.001). Among adults aged 65 and older with a phone preference, there were on average 8.39 calls over the course of the program with an average of 9.51 minutes per call over the course of 12-weeks. For those with text message preference, there were an average of 14.17 outbound and 8.30 inbound texts over the 12-week engagement, and for those with email preference a 62.38% open rate was observed. Retention over a three month coaching period was highest among those engaged via phone, text and email (56.17%), and email only (54.55%). Race was significantly related to engagement preference, with black members twice as likely (p < 0.001) to choose phone and text, and three times as likely (p < 0.001) to choose phone only compared with white members. However, no differences emerged between race and retention. Conclusions: Engagement preference was associated with differences in retention and race. Our results highlight the importance of offering different mechanisms for patient engagement and the need for attention to specific demographic differences such as race, which may impact access to and preference for engagement types when employing digital health solutions for older adults with cancer.

scholarly journals Humanizing the Chart: Becoming More Responsive to Patient Needs Through Implementation of PatientWisdom (Preprint)

2018 ◽  
Author(s):  
Bradley Crotty ◽  
Jeana Holt ◽  
Rachel Cusatis ◽  
Onur Asan ◽  
Joni Williams ◽  
...  
Keyword(s):  
Health Care ◽  
Health System ◽  
Patient Experience ◽  
Initial Assessment ◽  
Patient Needs ◽  
Contextual Data ◽  
Patient Goals ◽  
Electronic Health ◽  
The Impact ◽  
Improve Patient

BACKGROUND Over the past several decades, health care has been shifting to a care model that more fully values patient engagement. Recently, there has been increased attention on the role of health information technology that enables patients to collaborate with clinicians through the sharing of patient-generated contextual data. We implemented the PatientWisdom tool using a sociotechnical model to improve patient experience and visit effectiveness. OBJECTIVE To understand the facilitators and barriers to the routine incorporation of patient contextual data into the record, and the subsequent initial impact on the experience of care within academic and community practices affiliated with an academic health system. METHODS Our health system co-developed the PatientWisdom tool, which elicits patient values, preferences, and other contextual data ahead of visits through an email invitation to a secure Web application. Results are summarized and viewable within the EHR. To assess the implementation, we performed workflow shadowing and semi-structured interviews of clinical staff from April through July 2018. The Consolidated Framework for Implementation Research (CFIR) guided the collection and analysis of qualitative data. Researchers used the PatientWisdom platform to elicit patient data ahead of visits and summarize insights in the EHR. The researchers conducted sampling and data analysis in tandem; sampling concluded when the researchers determined no new themes were surfacing; therefore reaching data saturation. To assess the impact of the program on health care operations, including patient experience, a random sample of clinicians and patients (both users and non-users) was performed. RESULTS In workflow assessment and clinician interviews, we learned that the data needed to be more visible within the chart, and we made improvements within our electronic health record to make link to the data more apparent and visible when data were available. Main themes from our interviews were: Patient contextual information fosters a holistic approach to care; PatientWisdom is an innovative tool used to sync clinician-patient goals; clinicians may have an incorrect perception of PatientWisdom adopters (expecting millennials); and clinicians who proactively integrate PatientWisdom into their workflow identified it as an asset to care. In our initial assessment of impact, 945 patients completed surveys following their visits. Of participating patients, 87% say it improves communication and 90% rate the visit as going “extremely well” (compared to 82% when not used P<.05). Clinicians were significantly more likely to ask patients about barriers to care using the tool (65% vs 48%). The tool surfaced information about patient needs for clinicians and leaders. For example, we identified that 47% of participants did not have a health care proxy, and 60% of these patients were ready to talk about it with their clinician. CONCLUSIONS Consumer informatics tools that link with electronic health records may help “humanize” the record and improve patient centeredness. This session highlights the initial implementation of an effort to collect patient-contextual data through the PatientWisdom tool and highlights the use of the tool to drive clinical and operational improvement.

scholarly journals The impact of COVID‐19 on patient engagement in the health system: Results from a Pan‐Canadian survey of patient, family and caregiver partners

2022 ◽  
Author(s):  
Laura Tripp ◽  
Meredith Vanstone ◽  
Carolyn Canfield ◽  
Myles Leslie ◽  
Mary Anne Levasseur ◽  
...  
Keyword(s):  
Health System ◽  
Patient Engagement ◽  
The Impact ◽  
Canadian Survey

scholarly journals How to govern the digital transformation of health services

2019 ◽  
Vol 29 (Supplement_3) ◽  
pp. 7-12 ◽  
Author(s):  
Walter Ricciardi ◽  
Pedro Pita Barros ◽  
Aleš Bourek ◽  
Werner Brouwer ◽  
Tim Kelsey ◽  
...  
Keyword(s):  
Health Care ◽  
Health Services ◽  
Health System ◽  
Health Care System ◽  
Digital Health ◽  
Digital Transformation ◽  
Broad Perspective ◽  
Health Technologies ◽  
The Impact ◽  
Care System

Abstract The impact of digitalization of health services has been profound and is expected to be even more profound in the future. It is important to evaluate whether digital health services contribute to health system goals in an optimal way. This should be done at the level of the service, not the ‘digital transformation’. Decisions to adopt new digital health services, at different levels of the health care system, are ideally based on evidence regarding their performance in light of health system goals. In order to evaluate this, a broad perspective should be taken in evaluations of digital health services. Attainment of the broad health system goals, including quality, efficiency and equity, are objectives against which to judge new digital health services. These goals in a broad sense are unaltered by the process of digitalization. Governance should be designed and tailored in such a way to capture all relevant changes in an adequate way. When evaluating digital health services many specific aspects need to be considered. Like for other innovations and (new) technologies, such promises may or may not materialize and potential benefits may also be accompanied by unintended and/or negative (side) effects in the short or long term. Hence, the introduction, implementation, use and funding of digital health technologies should be carefully evaluated and monitored. Governments should play a more active role in the further optimization both of the process of decision making (both at the central and decentral level) and the related outcomes. They need to find a balance between centralized and decentralized activity. Moreover, the broader preparation of the health care system to be able to deal with digitalization, from education, through financial and regulatory preconditions, to implementation of monitoring systems to monitor its effects on health system performance remains important.

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