Live Better
Project status
Collaborators
Vandana Khungar, MD, MSc
Kimberly Forde, MD, PhD
Colleen Cook, BSN, RN
Diane Peyton, BSN
Ann Huffenberger, RN, DBA
Asim Viqar
Innovation leads
Awards
UPHS Quality and Patient Safety Award, 2018
Funding
Innovation Accelerator Program
Opportunity
It takes a lot of effort to keep cirrhosis and liver transplant patients out of the hospital. At Penn Medicine, approximately 29 percent of cirrhosis patients and 32 percent of patients who have a liver transplant are readmitted within 30 days of discharge – leading to an additional cost of more than $21 million to the health system.
Readmissions are inconvenient and dangerous for this patient population, as morbidity and mortality risk are increased in the hospital.
Intervention
Live Better is an automated hovering program designed to keep cirrhosis and liver transplant patients out of the hospital. Powered by Way to Health, the program prompts recently discharged patients to report highly predictive readmission indicators for this patient population – daily weight, mental function, medication adherence, and temperature – via text message.
Nurses enroll patients in the 30-day monitoring program before discharge, and patients are sent home with a wireless scale and thermometer to support biometric tracking. Live Better's lean staffing model leverages patient liaison and nurse oversight to monitor daily patient-reported outcomes, only escalating information to physicians if necessary.
Impact
Live Better's implementation resulted in a 43 percent reduction in 30-day readmissions in the initial pilot population, with only four percent of cases requiring escalation to a physician. And the total program cost per patient was reduced from $1,050 to less than $50, including equipment and staffing.
At scale, these results are projected to lead to a $6.8 million reduction in costs related to cirrhosis 30-day readmission costs and a $2.2 million decrease in costs for 30-day liver transplant readmissions annually.
The team has tested this intervention further in a pragmatic trial and is currently evaluating the results.
Way to Health Specs
Learn more about the platformInnovation Methods
Vapor test
Vapor test
Vapor test
Vapor test
We used a vapor test to identify the communication mode most preferred by cirrhotic and post-liver transplant patients.
During pilot enrollment, patients were offered email, text message, and telephone call options, even though sustainable communication channels for the program had not yet been established.
Based on the response, we decided to develop a text message communication protocol for the program.
Fake back end
Fake back end
Fake back end
It is essential to validate feasibility and understand user needs before investing in the design and development of a product or service.
A fake back end is a temporary, usually unsustainable, structure that presents as a real service to users but is not fully developed on the back end.
Fake back ends can help you answer the questions, "What happens if people use this?" and "Does this move the needle?"
As opposed to fake front ends, fake back ends can produce a real outcome for target users on a small scale. For example, suppose you pretend to be the automated back end of a two-way texting service during a pilot. In that case, the user will receive answers from the service, just ones generated by you instead of automation.
Fake back end
We designed a low-risk fake back end pilot to test the efficacy of a post-discharge monitoring program for this complex population.
During the pilot, the clinical team checked in daily with patients via text message and manually reviewed and escalated responses as needed, mimicking what an automated bot would eventually do.
This exercise helped us validate that we could in fact keep patients out of the hospital. It also allowed us to test frequency and framing options for check-in messages and elicit patient feedback before building a permanent solution.