Can a Mobile App Help Keep Patients Out of the Hospital After GI Surgery?

As the number of mobile health applications continues to skyrocket, a group of researchers set out to determine whether a smartphone app could prevent readmissions for patients released from the hospital after gastrointestinal (GI) surgery. The findings from the pilot study of the mHEALS app were presented at Digestive Disease Week 2017, which took place May 6-9 in Chicago, Illinois.

After GI surgery, patients are at risk of being readmitted to the hospital due to preventable complications like dehydration, malnutrition, ileus, and infections. Lead study author Matthew Symer, MD, of the NYP-Weill Cornell Medical Center, said that there are currently some interventions aiming to avoid readmissions, like using phone calls or discharge coaches, but “all of these interventions are very time-intensive and quite costly.” He and his colleagues theorized that a mobile app could be a cost-effective way to help identify potential complications as they begin to develop, which would alert the clinician to intervene before the issue worsens and necessitates a return to the hospital.

They created the app with input from GI surgeons and nurses on what metrics are most important to monitor after surgery, along with evidence from a review of the literature on readmission. The active components of mHEALS were daily messages reminding patients to stay hydrated, asking them to send photos of their wounds and urine, and prompting them to complete a quick survey about their pain levels and other potential indicators of complications. The survey questions and photo prompts took into consideration what type of surgery the patient had undergone (laparoscopic or open colorectal) and whether they had an ostomy.

The researchers displayed screenshots that gave examples of the types of multiple-choice survey questions and photo prompts used in the app, including “On average, what percent of your meals have you been eating over the last day?” and “Please take a picture of your stoma output.” Another component of the survey was the Photo Affective Meter, or PAM, which displayed photographs of people with various expressions and asked the patient to select the one that best represented their current mood. The app’s passive component tracked biometrics like sleep, heart rate, and step count using data from a wearable device, the FitBit.

If a patient reported an abnormal response, like a fever, the app sent an alert to both the patient and the provider, which “allowed them to get in touch with one another and see what was going on,” Symer said. The patients’ use of the app was monitored for 30 days after their operation.

During this study period, the app generated an average of 1.2 alerts per person; the only patient out of the 27-member cohort to be readmitted had generated 7 alerts before returning to the hospital due to gastroenteritis. Patients were asked to rate their pain on a scale of 1 to 10; the average rating was 4.2 on the first day after the operation, increasing to 5.1 on day 5 and declining to 3.8 on day 10 after the operation.

During the 30-day time frame, “75% of patients completed at least 60% of the available survey tasks, meeting our a priori definition of feasibility,” the study authors wrote. The highest participation rates were observed for collecting FitBit data, which were reported on 83.7% of the days. There was a 73% response rate for the single-item PAM, but just over half (52.7%) uploaded photos in response to all of the prompts, indicating they “had more difficulty regularly uploading photographs,” the study abstract said. Nevertheless, patient satisfaction with the app was high, as 91.7% reported the app was easy to use and 91.3% said they would recommend it to a friend.

Symer said that he believed the app had successfully prevented some readmissions, citing the example of a patient who submitted a photo of an abnormal-looking wound, triggering an alert, and was quickly treated in the clinic instead of potentially waiting until the wound worsened enough to require treatment in the emergency department.

After tweaking the app to make photo uploads easier, the researchers are now enrolling GI cancer patients in a randomized controlled trial of the app. In this study, Symer explained, the team is “again focusing on readmission, but this also provides a really wonderful opportunity for us to assess patient-reported outcomes, so we can see what their satisfaction with recovery is, what their quality of life is like, and how they’re doing with their functional status.”