JMIR Publications

ABSTRACT

Background:

INTRODUCTION PIP is a novel mobile healthcare application that combines both human health coaches (HC) and technology. The aim of this study was to test the feasibility of the combined approach in ensuring compliance with protocols at predefined touch-points in the patient journey and reporting impact on outcomes at a large academic health center.

Objective:

The aim of this study was to test the feasibility of the combined approach in ensuring compliance with protocols at predefined touch-points in the patient journey and reporting impact on outcomes at a large academic health center.

Methods:

METHODS This is an institutional review board (IRB) approved descriptive, prospective feasibility study of patients scheduled for elective surgery, invited to enroll in the PIP program from 2.5-4 weeks preoperatively through 4 weeks postoperatively at University of Pittsburgh Medical Center between 11/22/2022-3/27/2023. Descriptive primary endpoints included patient satisfaction, patient engagement, PIP HC evaluations, and other patient reported outcomes. Secondary endpoints included mean and median length of stay (LOS), rates of readmission within 7 and 30 days, and rates of emergency department (ED) utilization within 30 days. Secondary endpoints were compared between patients who received PIP vs. patients who did not receive PIP (1/1/2022-3/27/2023) using stabilized inverse probability of treatment weighting (SIPTW).

Results:

RESULTS Out of 283 patients invited, 172 patients (61%) were enrolled in PIP. 138 (97%) had ≥1 HC session and proceeded to surgery. 97 (70%) patients engaged with PIP post-operatively. PIP demonstrated an 82% weekly engagement rate with HCs with 27 days average lead time (range of 7-108 days) from enrollment to surgery. Patients attended an average of 6.7 HC sessions (range of 3-19). 93.75% attended the postoperative surgical appointment. 1.03% reported being diagnosed with a surgical site infection. Patients reported high satisfaction based on a survey (average score 4.8 out of 5, n=95). Patients strongly agree that HCs helped them throughout the perioperative process based on PIP HC evaluations (average score 4.97 out of 5, n=33). Average Net Promotor Score rating score was 9.7 out of 10. A total of 268 patients in the non-PIP group and 128 patients in the PIP group had appropriate overlapping distributions of SIPTW for the analytic sample. The PIP cohort was associated with average and median reductions in length of stay when compared to the non-PIP cohort (mean 2.4 vs. 3.1 and median 1.9 vs. 3.0). PIP care was significantly associated with a 24% reduction in post-op LOS (mean ratio: 0.76; 95%CI: 0.62-0.93). PIP was associated with 49% lower risk in 7-day readmission (relative risk: 0.51; 95%CI: 0.11-2.31) and 17% lower risk in 30-day readmission (relative risk: 0.83; 95%CI: 0.30-2.31), but they were not found to be statistically significant. PIP and non-PIP groups had similar risk in 30-day ED returns (relative risk: 1.06; 95%CI: 0.56-2.01).

Conclusions:

DISCUSSION PIP is a novel mobile healthcare application that combines both human health coaches and technology, valuable to patients in their perioperative journey, associated with reduced hospital length of stay and potential risk reduction for hospital readmissions.