JMIR Publications

ABSTRACT

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.