JMIR Publications

ABSTRACT

Background:

To fill the communication and care coordination gap between hospitals and dialysis facilities, we piloted a web-based, provider-driven mobile app (“DialysisConnect”). Here, we describe its development and pilot implementation.

Objective:

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Methods:

DialysisConnect was developed iteratively, with focus group and user testing feedback, and made available to 106 potential users at one hospital [hospitalists, advanced practice providers (APPs), care coordinator] and four affiliated dialysis facilities (nephrologists, APPs, nurses/nurse managers) prior to the start of the pilot (11/1/20-5/31/21). Mid- and end-of-pilot online surveys of potential users were performed. Descriptive statistics were used to describe system usage patterns, ratings on multiple satisfaction items (1=not at all; 3=to a great extent), and provider-selected motivators and barriers to using DialysisConnect.

Results:

The pilot version of DialysisConnect included automatically uploaded clinical information from dialysis facilities, forms for entering critical admission and discharge information, and a direct communications channel. While physicians comprised most of the potential users of DialysisConnect, APPs and dialysis nurses were the most active users. Activity was unevenly distributed: e.g., one hospital-based APP recorded most of the admissions (n=225, 89%) and discharges (n=226, 93%) among patients treated at the pilot dialysis facilities. End-of-pilot ratings of DialysisConnect were generally higher for users vs. non-users: e.g., “I can see the potential value of DialysisConnect for my work with dialysis patients” [mean (SD): 2.8 (0.4) vs 2.3 (0.6), P=0.02]. Providers most commonly selected reduced time and energy spent gathering information as a motivator (42.3%) and lack of time to use the system as a barrier (30.8%).

Conclusions:

In this pilot, we found that APPs and nurses were most likely to engage with the system. Survey participants generally viewed the system favorably, while identifying substantial barriers to its use. These results inform how best to motivate providers to use this and similar systems and inform future pragmatic research in care coordination in this and other populations.