INTERACTIVE DIGITAL HEALTH TOOLS TO ENGAGE PATIENTS AND CAREGIVERS IN DISCHARGE PREPARATION: IMPLEMENTATION EXPERIENCE

Anuj Dalal, MD1, Theresa Fuller2, Nicholas Piniella, Denise Pong, Michael Pardo, Nathaniel Bessa, Catherine Yoon, MS, Robert Boxer, MD,PhD, Jeffrey Schnipper, MD, MPH, FHM, 1ASSISTANT PROFESSOR, HARVARD MEDICAL SCHOOL; 2Brighton, MA

Meeting: Hospital Medicine 2019, March 24-27, National Harbor, Md.

Abstract number: 383

Categories: Hospital Medicine 2019, Research, Technology in Hospital Medicine

Keywords: , , , , ,

Background: Sub-optimal discharge preparation during hospitalization may adversely impact safety and lead to a poor patient experience. As part of an AHRQ-funded study, we designed and developed interactive digital health tools (Figure 1) to engage patients and caregivers in self-assessing discharge preparedness: an educational video and 16-item discharge checklist addressing 4 domains (understanding the plan, medications, self-care, follow-up) administered to patients 24-48 hrs prior to their expected discharge date (EDD); a safety dashboard integrated into the electronic health record (Epic, Inc.) displaying patient-reported discharge concerns from the checklist for clinicians to view in real-time; and a mechanism for patients to request secure text messaging with a physician to address issues that arise after discharge for up to 7-days. The purpose of this study was to evaluate our implementation experience.

Methods: This IRB approved study was conducted on general medicine units at a large academic medical center in Boston, MA from 1/2018 through 8/2018. Research assistants approached patients or a designated healthcare proxy for enrollment. Research assistants coached patients/caregivers to watch the video and complete the checklist on a mobile device (patient portal or web-based REDCap survey). We categorized reasons for non-participation. We used descriptive statistics to quantify frequency of patient-reported discharge concerns by domain as well as usage of each component. We used a 2-person consensus approach to analyze qualitative data collected from interviews and focus groups of patients and clinicians to identify implementation barriers.

Results: Of 756 patient-admissions, the discharge checklist was successfully submitted for 510 (67.5%) patients (480 unique patients, mean age of 58.6 ±17.9 yrs; 230 (45.1%) male; 340 (66.7%) Caucasian; 305 (59.8%) government insurance, mean LOS of 8.78±7.93 days). For the remaining 246 patient-admissions, the patient was unavailable (126); not appropriate per nurse (97); declined to participate (41); did not speak English / no caregiver was available (33); did not respond by email when reminded (8); or encountered technical issues (8). The video was watched prior to completing the checklist in 416 (81.6%) patient-admissions. On average, patients reported 4.24 concerns based on checklist responses, most commonly about medications (30.7%) and follow-up (30.3%). In 210 (41.2%) patient-admissions, a member of the patient’s care team–most often a nurse–accessed the dashboard discharge column to view concerns. For 422 patient-admissions in which secure messaging was offered, 141 (33.4%) patients provided their mobile number during checklist submission; of these, a communication thread was initiated by a physician for 3 (2.1%) discharges. From our qualitative analysis, we identified 10 key implementation barriers.

Conclusions: Most patients approached were willing to watch a video and complete a checklist to self-assess discharge preparation, and many reported concerns about medications and follow-up. Use of the dashboard by clinicians was modest and could be improved by improving specificity of patient-reported concerns, linking to clinical actions, and stratifying patients by readmission risk. Novel features, such as post-discharge texting, likely require institutional and policy-level changes to facilitate adoption. The strategies (Table 2) we propose could help address implementation barriers and promote adoption.

IMAGE 1: Figure 1 & Table 1

IMAGE 2: Table 2

To cite this abstract:

Dalal, AK; Fuller, T; Piniella, N; Pong, D; Pardo, M; Bessa, N; Yoon, C; Boxer, R; Schnipper, JL. INTERACTIVE DIGITAL HEALTH TOOLS TO ENGAGE PATIENTS AND CAREGIVERS IN DISCHARGE PREPARATION: IMPLEMENTATION EXPERIENCE. Abstract published at Hospital Medicine 2019, March 24-27, National Harbor, Md. Abstract 383. https://www.shmabstracts.com/abstract/interactive-digital-health-tools-to-engage-patients-and-caregivers-in-discharge-preparation-implementation-experience/. Accessed November 15, 2019.

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