At the 2019 Southeastern Surgical Congress, Atrium Health presented on its success using SeamlessMD in Hepatobiliary Surgery for patient engagement and collecting Patient-Reported Outcomes (PROs).
The following is an excerpt from Pharmacy Practice News. The original link can be found here:
App Engages Surgery Patients Through Enhanced Recovery Process
Study Hints at Better Patient Experience, Streamlined Feedback With Surgeon
By Monica J. Smith
CHARLOTTE, N.C.—Use of a mobile app in patients undergoing hepatopancreaticobiliary procedures in an enhanced recovery after surgery program may improve tracking of both patient-reported outcomes and compliance with enhanced pathway items, according to new research that found the app feasible and potentially transformative of patient care.
“PROs [patient-reported outcomes] are one of the most important ways to measure a patient’s experience and recovery, particularly in the first phase after discharge when contact with patients is limited. But traditional PROs are time- and resource-intensive, often very intermittent, and depend on patients’ recall of their experience,” said Ryan Pickens, MD, a general surgery resident and current research fellow in the Division of HPB at Carolinas Medical Center, in Charlotte.
Furthermore, he added, by the time PROs are assimilated, analyzed and reported back to surgeons, they are often out-of-date and have no meaningful effect on real-time patient care.
“We sought to evaluate how mobile technology can help us in this regard,” said Dr. Pickens, who presented the study at the 2019 Southeastern Surgical Congress.
For this pilot project, all patients enrolled in an enhanced recovery after surgery (ERAS) pre-education class before hepatectomy, distal pancreatectomy or pancreaticoduodenectomy were invited to take part in the study. The 122 who accepted the invitation were then given daily task reminders and access to customized education materials, all prompted through a comprehensive app on their personal phone or tablet.
From the day of surgery through postoperative day 30, patients received prompts for daily health checks and compliance with ERAS pathway items, and intermittent quality-of-life (QOL) surveys. Of note, unlike most apps that have been developed and studied for use either during a patient’s hospital stay or post-discharge, this one, developed by SeamlessMD, was designed to be used through all perioperative phases up to day 30.
“The app, which was customized for these patients, was linked between specific patients and their specific surgeon to create a very integrated pathway,” Dr. Pickens said.
The primary goals of the study were patient adoption, PRO response and patient satisfaction; the secondary goals were quantification of the app’s ability to capture and track specific PROs for patient symptoms, QOL and compliance to ERAS pathway items.
Over the course of the 10-month study period, 93% of patients engaged with the app in the preoperative setting, and 88% remained engaged during their hospital stay.
“We had nurses help to teach them maneuvers with the app, but they weren’t prompted and required to use it, so this was all of their own accord,” Dr. Pickens said. “We thought the 88% engagement was remarkable, considering HPB patients are typically quite ill before surgery and undergo a major operation.”
Patient engagement with the app declined significantly post-discharge, as patients recovered and likely had fewer symptoms to report. But about 50% of the patients continued to provide responses to prompted surveys throughout their recovery at home.
“The 93% adoption rate was significantly over our projected target,” Dr. Pickens said. Overall, the patient response rate for PROs on QOL, postoperative pain and nausea, use of narcotic medication and compliance with ERAS pathway items was 62%, also above the researchers’ target.
Patient satisfaction with the app also was high, with 86% indicating they would recommend the app, 97% indicating they felt more prepared for surgery, and 78% indicating they felt more confident and less worried after surgery.
As for their secondary goals, evaluating the app’s performance, Dr. Pickens and his colleagues found the technology successfully tracked patient symptoms based on their surgery type throughout the hospital stay and post-discharge phases up to postoperative day 30 with a single integrated platform, as well as capturing PROs. They were also able to capture and track ERAS pathway items compliance.
“Though the overall number of patients who responded to these questionnaires was a little lower than our average survey response, it still represents a unique way to capture this data and help patients engage in their perioperative plan,” Dr. Pickens said.
One unanticipated aspect of the app the researchers recognized throughout the study was its power to triage patient concerns. After discharge, patients submitted 521 health checks tracking their symptoms and recovery progress, answering questions customized by the HPB surgeons. Among these patients, 12 reported that the app prevented one or more phone calls to the office, and three reported the app provided sufficient reassurance about their recovery to divert them from an unnecessary ER visit.
“Conversely, the app also helped triage concerns and automatically prompt patients to seek earlier care for specific warning signs; there were 121 prompts to patients to call the HPB nurse, and nine patients were instructed to go to the ER,” Dr. Pickens said.
Perry Shen, MD, an HPB surgeon at Wake Forest Baptist Medical Center, in Winston-Salem, N.C., noted that mobile digital health apps have been generating interest for their potential to help patients play a more active role in their health management, and to provide their physicians with timely information on how they’re doing.
“This study demonstrates the feasibility of this approach in a small series of patients, and we look forward to learning more about the application and its impact on clinical outcomes,” he said.
A Pharmacist's View
Margaret Malovrh, PharmD, a pharmacy clinical supervisor at Sparrow Health System, in Lansing, Mich., said she thought the app could be a very useful tool for validating the stated benefits of ERAS protocols.
“I see this mobile app as a convenient tool for providing feedback to the health care team,” Dr. Malovrh said. “Further studies demonstrating that the app can facilitate clinical interventions between health care providers and patients would add significant value to this tool.”