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PITTSBURGH, April 4, 2024 – Coupling a smartphone app with a real-life health coach appears to be key to helping patients adhere to presurgical preparation and postsurgical recovery guidance and improving surgical outcomes, according to new findings led by UPMC and University of Pittsburgh School of Medicine physician-scientists.
The research, published today in the Journal of Medical Internet Research, found that patients who used the digital health platform—named Pip Care—had to stay in the hospital for nearly a day less than their counterparts who did not use the app, and they cut in half their risk of readmission within a week of surgery.
“Study after study has shown that patients are healthier and have better surgical outcomes when they adhere to a perioperative care plan – but ensuring that adherence is easier said than done,” said senior author Aman Mahajan, MD, PhD, Peter and Eva Safar Professor and Chair of the Department of Anesthesiology and Perioperative Medicine at Pitt. “So, verifying that this hybrid digital-telemedicine platform is both easy for patients and clinicians to use and significantly improves patient outcomes and satisfaction with surgery is a welcome clinical advance.”
Mahajan and lead author Stephen Esper, MD, associate professor of anesthesiology and perioperative medicine at Pitt and director of the UPMC Center for Perioperative Care, are clinical advisors for Pip Care, which receives funding from UPMC Enterprises, the innovation, commercialization, and venture capital arm of UPMC.
Several digital health platforms that use mobile apps to provide perioperative instructions to patients have been deployed over the last few years, but outcomes have been mixed. Pip Care is the first to pair the digital platform with one-on-one telehealth coaches who check in with patients regularly and assist them in care coordination so they can achieve their surgical goals.
In preparation for elective surgery, doctors will often recommend patients follow evidence-based protocols—known as “prehabilitation”—to improve their health. These can include improving their nutrition, physical conditioning, psychological support, and stopping smoking. Pip Care helps patients adhere to these protocols by simplifying the doctor’s presurgical instructions into easy-to-understand and complete daily tasks. The health care coach answers questions and keeps the patient accountable. Finally, Pip Care also simplifies and coaches patients through postsurgical care, such as understanding discharge instructions, wound care, and the importance of proper pain management.
“Think of having major surgery as running a marathon,” said Esper. “If you want to perform your best, you don’t just show up and run. You have to train first and get your body ready for the stress. It’s similar with surgery – by optimizing your health beforehand you have a better recovery.”
To determine the impact of this approach, the research team compared 128 patients enrolled in Pip Care who were scheduled for elective abdominal, spine, or total joint replacement surgery to 268 peers scheduled for the same surgeries at the same hospitals who did not use Pip Care. The patients using Pip Care were enrolled about 2.5 to 4 weeks before surgery and continued using it for 4 weeks after surgery.
On average, Pip Care patients remained hospitalized after surgery for 2.4 days, while non-Pip patients stayed in the hospital for 3.1 days. Additionally, Pip Care patients had a 49% lower risk of being readmitted to the hospital within a week of discharge, compared to their non-Pip counterparts.
The patients who received Pip Care attended an average of 6.7 sessions with their digital health coach, with 82% attending sessions at least once a week. Additionally, in follow-up surveys, patients reported high scores—4.8 out of 5 points—for satisfaction with the app.
“Many health systems are facing considerable staff shortages and one of the consequences is that clinical teams, who are dedicated to their patients’ success, have limited time to provide focused, patient-specific surgical optimization,” said Mahajan, who is also the Senior Vice President, Health Innovation, Enterprises, UPMC. “By partnering with health systems and hospitals Pip Care is providing patients a sense of connection and a better understanding of their surgical journey, prompting them to actively engage in their health and those patients have better surgical outcomes.”
Additional authors on this research are Jennifer Holder-Murray, MD; Katie Meister; Hsing-Hua Sylvia Lin, PhD; David K Hamilton, MD; Yram Groff, MD; and Brian Zuckerbraun, MD (all are associated with Pitt, UPMC, or both).
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About the University of Pittsburgh School of Medicine
As one of the nation’s leading academic centers for biomedical research, the University of Pittsburgh School of Medicine integrates advanced technology with basic science across a broad range of disciplines in a continuous quest to harness the power of new knowledge and improve the human condition. Driven mainly by the School of Medicine and its affiliates, Pitt has ranked among the top recipients of funding from the National Institutes of Health since 1998. In rankings released by the National Science Foundation, Pitt is in the upper echelon of all American universities in total federal science and engineering research and development support.
Likewise, the School of Medicine is equally committed to advancing the quality and strength of its medical and graduate education programs, for which it is recognized as an innovative leader, and to training highly skilled, compassionate clinicians and creative scientists well-equipped to engage in world-class research. The School of Medicine is the academic partner of UPMC, which has collaborated with the university to raise the standard of medical excellence in Pittsburgh and to position health care as a driving force behind the region’s economy. For more information about the School of Medicine, see www.medschool.pitt.edu.
About UPMC
UPMC is a world-renowned, nonprofit health care provider and insurer committed to delivering exceptional, people-centered care and community services. Headquartered in Pittsburgh and affiliated with the University of Pittsburgh Schools of the Health Sciences, UPMC is shaping the future of health through clinical and technological innovation, research, and education. Dedicated to advancing the well-being of our diverse communities, we provide more than $1 billion every year in community benefits, more than any other health system in Pennsylvania. Our 100,000 employees—including more than 5000 physicians—care for patients across 40 hospitals and 800 doctors’ offices and outpatient sites in Pennsylvania, New York, and Maryland, as well as overseas. UPMC Insurance Services covers more than 4 million members with a focus on providing the highest-quality care at the most affordable price. To learn more, visit UPMC.com.
Original article:
Esper SA, Holder-Murray J, Meister KA, Lin HHS, Hamilton DK, Groff YJ, Zuckerbraun BS, Mahajan A
A Novel Digital Health Platform With Health Coaches to Optimize Surgical Patients: Feasibility Study at a Large Academic Health System
JMIR Perioper Med 2024;7:e52125
doi: 10.2196/52125PMID: 38573737