Purpose: A transitions-of-care bundle was developed to improve the post-discharge experience for patients diagnosed with acute VTE. The bundle integrates social work-driven patient navigation with a patient-facing mobile app developed for this purpose. The goal is to reduce recurrent VTE, bleeding complications, and readmissions, and to improve communication.
Description: A pilot bundle was implemented in May 2016. Patients diagnosed with acute VTE in-hospital or in the emergency department were eligible. Patients were followed for three months. The bundle includes:
- HealthFLO, an iOS/Android app providing interactive SMS medication reminders, secure messaging, and VTE patient education.
- A VTE patient navigator (PtN) who engages patients in-hospital and communicates with them after discharge via the app and telephone. The PtN connects patients and providers to address clinical questions and psychosocial care barriers, monitors the cohort and their responses to SMS medication reminders, and intervenes as needed.
To date, 29 patients were enrolled. 10 patients downloaded the app. Reasons for app declination included discomfort with mobile apps and lack of smartphone. 8/10 app users responded to at least one SMS reminder; the mean response rate was 32.1% (range, 0%-87.5%). There were four 30-day readmissions to our hospital (13.8%; baseline=13%, p=0.9) and one known outside hospital readmission. Two readmissions were for bleeding. The PtN scheduled urgent clinic visits for four patients and assisted with medications, transportation, medical equipment, housing, and access to mental health care.
Conclusions: A care bundle integrating a mobile app and care navigation demonstrated the potential to assist in the post-hospital transition for patients with acute VTE. Early experience suggests that navigation may support VTE patients in their self-care, though not all navigation was VTE-related. Barriers to app utilization included lack of smartphone, discomfort with mobile apps, and concerns about the app interface. To address this, an updated version with an improved interface will be released shortly and strategies to reach patients uncomfortable with apps will be explored. The effect of the bundle on recurrent VTE, bleeding complications and readmissions will be determined once a sufficient number of patients are enrolled. This pilot highlights the importance of testing mobile technology in a focus group prior to deployment in a care bundle.
To cite this abstract:Goodman, ER; Pearson, JM; Sperber, D; Weinstein, S; Atreja, A; Raucher, B; Dunn, A . BUNDLING A SMARTPHONE APP AND PATIENT NAVIGATION TO IMPROVE COMMUNICATION AND REDUCE POST-DISCHARGE COMPLICATIONS FOR PATIENTS WITH ACUTE VENOUS THROMBOEMBOLISM. Abstract published at Hospital Medicine 2017, May 1-4, 2017; Las Vegas, Nev. Abstract 248. Journal of Hospital Medicine. 2017; 12 (suppl 2). https://www.shmabstracts.com/abstract/bundling-a-smartphone-app-and-patient-navigation-to-improve-communication-and-reduce-post-discharge-complications-for-patients-with-acute-venous-thromboembolism/. Accessed April 1, 2020.