Impact of an automated peri-procedural digital health intervention on rates of emergency department visits and readmissions

Andrew W Liu; Logan Pierce; Smitha Ganeshan; William Brown 3rd; Timothy Judson; Dileesh Divakaran; Stefano Bini; Anobel Y Odisho; Michelle Mourad

doi:10.1016/j.amjsurg.2023.07.037

Impact of an automated peri-procedural digital health intervention on rates of emergency department visits and readmissions

Am J Surg. 2023 Nov;226(5):598-602. doi: 10.1016/j.amjsurg.2023.07.037. Epub 2023 Jul 27.

Authors

Andrew W Liu¹, Logan Pierce², Smitha Ganeshan², William Brown 3rd³, Timothy Judson⁴, Dileesh Divakaran¹, Stefano Bini⁵, Anobel Y Odisho⁶, Michelle Mourad⁷

Affiliations

¹ Center for Digital Health Innovation, University of California, San Francisco, San Francisco, CA, USA.
² Center for Digital Health Innovation, University of California, San Francisco, San Francisco, CA, USA; Department of Medicine, University of California, San Francisco, San Francisco, CA, USA.
³ Center for Digital Health Innovation, University of California, San Francisco, San Francisco, CA, USA; Department of Medicine, University of California, San Francisco, San Francisco, CA, USA; Bakar Computational Health Sciences Institute, University of California, San Francisco, CA, USA.
⁴ Center for Digital Health Innovation, University of California, San Francisco, San Francisco, CA, USA; Department of Medicine, University of California, San Francisco, San Francisco, CA, USA; Office of Population Health, University of California, San Francisco, USA.
⁵ Department of Orthopedic Surgery, University of California, San Francisco, San Francisco, CA, USA.
⁶ Center for Digital Health Innovation, University of California, San Francisco, San Francisco, CA, USA; Department of Urology, University of California, San Francisco, San Francisco, CA, USA.
⁷ Center for Digital Health Innovation, University of California, San Francisco, San Francisco, CA, USA; Department of Medicine, University of California, San Francisco, San Francisco, CA, USA. Electronic address: Michelle.Mourad@ucsf.edu.

PMID: 37604749
DOI: 10.1016/j.amjsurg.2023.07.037

Abstract

Background: Providing timely peri-procedural education, reminders, and check-ins can improve patient adherence and clinical outcomes. We sought to retrospectively evaluate the impact of a peri-procedural digital health tool on emergency department (ED) visits and readmissions.

Methods: A digital health tool for peri-procedural care engaged patients at scheduled intervals, resulting in an overall engagement score. Multivariate models determined predictors of tool engagement and post-procedural 30- and 90-day rehospitalizations and ED visits.

Results: 11,737 unique completed procedures were analyzed from 10,438 patients. Patients of Black and Latinx race/ethnicity (vs White), those with Medicare and Medicaid insurance (vs commercial), and those with non-activated patient portals (vs activated) were less likely to engage. After adjustment for confounders, higher engagement with the tool was associated with lower rates of 30-day hospitalizations (OR 0.64), 90-day hospitalizations (OR 0.65), and 90-day ED visits (OR 0.77).

Conclusions: Highly engaged patients had fewer 30-day and 90-day ED visit and readmissions, even after adjustment for key confounders. Engagement, and thus the resulting benefits, were not equitably distributed.

Keywords: Digital health; Patient outcomes; Peri-procedural care; Quality and safety; Remote patient monitoring.

MeSH terms

Aged
Emergency Service, Hospital
Hospitalization
Humans
Medicare*
Patient Readmission*
Retrospective Studies
United States