Hospitals and health systems across the United States are seeking ways to better engage patients with a variety of handheld and home-based technologies to improve patient experience and health outcomes. How do you use technology to transform the hospital bedside? Increase medication adherence for hypertension? Control diabetes? Reduce distress in patients with cancer?
Four health care organizations, including UC San Diego Health, Ochsner Health System, Sutter Health and Stanford Health Care, have all developed answers to these questions. All have created diverse models of care that incorporate use of patient-centered technologies with measureable outcomes. Their efforts and results will publish in the March 2019 edition of Health Affairs.
"Health care organizations are actively developing consumer technologies to help patients better manage their health," said Ming Tai Seale, PhD, MPH, lead author and director of outcomes analysis at UC San Diego Health and professor of family medicine and public health at UC San Diego School of Medicine. "The ultimate goal of these technologies, in academic and community settings, is to improve health outcomes through patient engagement. This paper offers a case study of successful approaches that can be replicated nationally."
Select project examples include:
- Ochsner Health System used their online patient portal to help treat hypertension with a novel digital medicine program that combined patient-reported blood pressure data, clinical data and coaching. Outcomes showed that medication adherence among patients improved 14 percent while 79 percent achieved greater blood pressure control. Overall, clinicians saw a 29 percent reduction in clinic visits.
- Sutter Health used their patient portal to help patients self-manage their diabetes. Online reminders of hemoglobin A1c monitoring among patients with diabetes improved the rate of A1c test completion by 33.9 percent. Overall, patients with previously uncontrolled diabetes had a significant reduction in HbA1c at six months compared to usual care.
- Stanford Health Care used their patient portal to help patients with cancer manage stress. Patients were surveyed before clinic visits to identify unaddressed symptoms. About 40 percent of patients who responded reported experiencing distress. These responses led to more than 6,000 referrals for psychotherapy, nutrition and other services.
"What we are seeing is that technology can be used to help patients be more autonomous and to improve their health in partnership with their clinical teams," said Chris Longhurst, MD, Chief Information Officer and Associate Chief Medical Officer at UC San Diego Health. "These benefits can be achieved at home but also inside the hospital where patients have a great desire to directly manage their room environment and access to information that impacts their medical care."
In 2016, UC San Diego Health opened Jacobs Medical Center, a 245-bed hospital that offers advanced surgery, cancer care, cardiac rehabilitation, and birthing options. To put patients in direct control of their experience, an Apple tablet was placed in every patient room. The tablets enable patients to control room temperature, lighting and entertainment options, all from their beds. The tablets also enable access to personal medical information, such as test results and schedules of medications or upcoming procedures. Photographs and biographies of their care team are also available.
"What we saw in our Press Ganey surveys is that a significant number of patients mentioned the tablets as contributing to a positive patient experience," said Longhurst. "Additionally, we saw that engagement in medical care, as measured by accessing their medical record, is higher among patients who pick up the tablet for room control purposes.
"Our analysis suggests that the odds of using the inpatient patient portal among room control users were 1.65 times greater than the odds for patients who didn't use the tablet for room control. This suggests that the tablet has served as a conduit that nudged more patients to use the patient portal and thus use resources to improve their health," added Longhurst.
Additional co-authors include: N. Lance Downing and Christopher Demuth Sharp from Stanford Health Care; Veena Goel Jones and Albert Chan from Sutter Health; Richard Milani from Ochsner Health System; and Bequin Zhao and Brian Clay from UC San Diego.