ThePREDICTTrial

PredictionusingaRandomizedEvaluationofDatacollectionIntegrated

throughConnectedTechnologiesOgochukwu Ufio

Advisors:Mitesh PatelMD,MBA,MSCarolineCarney,BA

TableofContents

• AboutNudgeUnit• Background• PACUREstudy• ProjectSignificance• Methods• Challenges• MyRole/LessonsLearned

AboutNudgeUnit

MissionTheNudgeUnitaimstoleverageinsightsfrombehaviouralsciences,principallybehaviouraleconomics,todesignandtestinterventionsthatsteerprovidersandpatientstowardbetterdecisionstoimprovehealthcaredeliveryandoutcomes

ChangingdefaultprescriptionsettingsinEMRincreasedratesofgeneric

drugs• ChangeindefaultimplementedacrossUPHSfrombrandnametogenericprescription

• Optoutmechanismincreasedgenericprescribingratesfrom75%to98%

• Genericsdrugsassociatedwithhighermedicationadherence,improvedclinicaloutcomesandreducedcosts.

• Behavioraleconomictechniquechangingphysicianandpatientbehaviour

Mitesh etal,2016

NudgeUnitProjects• PriceTransparency forinpatientlaboratorytesting(PRICETrial)

• Usingactivechoiceandpeercomparisonstoincreasestatinprescriptionrates(PRESCRIBETrial)

• Usingdefaultoptionstoincreasegenericmedicationprescribingrates(PrescriptionDefaults)

• Usingdefaultoptionstodecreaseopioidprescribingdurations(OpioidPrescriptionDefaults)

• Gamification andincentivespromoteweightloss(theLoseitTrial)

• Gamification andsocialincentivestoimproveglycemiccontrolamongobesediabeticadults(iDiabetes Trial)

RiskPredictionModelsforHospitalReadmission:ASystematicReview

• Objective– summarizevalidatedreadmissionriskpredictionmodels

– describetheirperformance– assesssuitabilityforclinicaloradministrativeuse

• Conclusion– 26modelswereassessedandfoundtoperformpoorly– Focusesprimarilyonclaimsdata&EHR

Devan etal,2011

Variablesconsideredbystudiesinevaluatingtheriskofreadmission

Variable Includedinfinalmodelin(n) outof26models

Medical comorbidities 24

Mental healthcomorbidities(mentalhealthillness,substanceabuse)

9-11

Illnessseverity 1-4

Priorutilization(hospitalizations,ERvisits,clinic visits,indexhospitallengthofstay)

4-14

Overall healthandfunction(mobility,visual,hearing,cognitivestatus)

1-7

Socialdemographic factors(age,race/ethnicity,gender)

7-19

Socialdeterminants ofhealth(SES,Education,insurancestatus,socialsupport)

0-5

Fewmodelsincludedvariablesassociatedwithoverallhealthandfunction,illnessseverityandsocialdeterminantsofhealth

Devan etal,2011

PACURERetrospectiveStudy• AseparatestudyfromthePREDICTTrial• Examinesretrospectivedataonpatientsadmittedand

dischargedbetween1/1/2012and9/30/2014fromUPHS• Standardpredictionmodelapproachusingclaimsdataand

EHRdata• Additionalvariables:social/behaviouraldeterminantsof

health- continuityofcare&substanceabuse• 9080patientshavebeenidentified

HowthisstudydiffersfromPREDICT• PREDICTisanenhancedapproach• PREDICTbuildsonthisstudybyusingstep,sleepandsurvey

data

PREDICTTrialSignificance

• Whatisalreadyknownonthistopic– Transitioncareinterventionscanreducereadmissions– Identifyinghighriskpatientscanreducereadmissions– Existingpredictionmodelsperformpoorly– Priorstudiesfocusedonclaimsdataandelectronichealthrecords

• Whatquestionthisstudyaddresses– Whatcanlearningaboutpatient’sstepsandsleepingtellusabouttheirlikelihoodforreadmissions?

Thepassiveintervention:

WatchOR PhoneApp

Project’sSignificance

• Whatthisstudyaddstoourknowledge– Collectsanintegrateddataset– Comparesmethodsofactivitydatacollection

• Howisthisrelevanttopolicyandpractice– Improvereadmissionpredictionmodels– Aplatformfordesigningfutureinterventions– Forstateandnation-wideimplementation

Method

• ApproachPatient• UPHShospitals• Assessinterest

Consent

• CreateaWTHaccount

• Completeaseriesofsurveys

Enroll • Activityistrackedusingphoneorwatch

• Duration- 6months

Randomize

•18yearsorolder•Abilitytoprovideconsent•AdmittedpatientatHUPorPennPresby MedCenter•SmartphonecompatibletoNokiaHealthMate•Walk10-15minute/Nohiporfootsurgery•Dischargedhome•LiveinPA/NJ•Hasanemailaddress

Aseriesofselfreportedsurveysonpatientexperiences

• MedicalOutcomeStudySurvey– Assessesphysical,mentalandgeneralhealth

• DOSPERTRiskpreferences– Assessesrisktakinganduncertainty

• MMAS-8– Assessesmedicationtakingbehaviour

• BigFivePersonalitytest– Assessmentofpersonalityacross5dimensions:Openness,Conscientiousness,Agreeableness,Extraversion,Neuroticism

• IPAQ-SF– Assessesphysicalactivitylevels

Method

• ApproachPatient• UPHShospitals• Assessinterest

Consent

• CreateaWTHaccount

• Completeaseriesofsurveys

Enroll • Activityistrackedusingphoneorwatch

• Duration- 6months

Randomize

ComparingMethodsofTrackingActivityData

PhoneAppn=250

• Tracksstepcountsonly

• Lowercostforintervention

Watchn=250

• Tracksbothstepsandsleepingpattern

• Challengesinadoption

500patientsenrolled

NokiaHealthMate AppFeatures• Steps

– Trackswalk,runand10+activities– Competewithfriendsandfamily

• Sleep– Assesseshowmuchsleepscheduleisshiftedandsleepduration

– Trackspatternandgraphstrends• Weight

– Monitorweighthistoryintheformofagraph– Useconnectedscalestomeasureweight– Thisfunctionalityisusedinthe iDiabetes study

• Heart– Monitorsheartrate– MonitorsbloodpressuremanuallyorviawirelessBPmonitor

BehaviourModification• Patientshaveaccesstoactivitydatacollectedthroughapp

• Setdailystepgoals• Trackprogressovertime• Congratulatorybadges

Approached (n=672)

Excluded (n=585)

•Not meeting inclusion criteria (n=293)

No smartphone (n=154)Not being discharged to home (n=66)Unable to walk (n=45)Not PA/NJ resident (n=10)Not English speaking (n=6)

•Declined to participate (n=293)

Phone App Group (n= 45)

AllocationRandomized (n=84)

Enrollment

App and Activity tracking watch (n= 44)

6monthpassivestepcollection

Reminderafter4daystopleaseopenapp

AddressingLowrecruitment

84patientsenrolled

Logisticsofrecruitingonhospitalfloors

Changingandhiringstaff

Goal=500patients

•WatchrebrandedonJune20•ChangedAPI•CausedtechnologicaldisconnectionswithWaytoHealth

Role&TakeAways

• Recruitingpatients– Patientengagement– Managingpatientquestions– Datacollectionprocess

• Literaturesearch/review– Identifyingrelevantandtimelyresearcharticles

• Dealingwithprojectchallenges• Contributingtoprojectmeetings

Acknowledgement

Mitesh PatelJoanneLevyCarolineCarneySafa BrowneNudgeUnitTeamHoagLevins

SUMR2017Cohort

Thankyou!

Questions?

ReferencesColemanEA,ParryC,ChalmersS,MinSJ.Thecaretransitionsintervention:resultsofarandomizedcontrolledtrial.ArchInternMed2006;166:1822-8.Kansagara D,EnglanderH,Salanitro A,etal.RiskPredictionModelsforHospitalReadmission:ASystematicReview. JAMA :thejournaloftheAmericanMedicalAssociation.2011;306(15):1688-1698.doi:10.1001/jama.2011.1515.Mitesh S.Patel,SusanC.Day,ScottD.Halpern,C.WilliamHanson,JosephR.Martinez,StevenHoneywell,KevinG.Volpp.GenericMedicationPrescriptionRatesAfterHealthSystem–WideRedesignofDefaultOptionsWithintheElectronicHealthRecord.JAMAInternalMedicine,2016NaylorMD,Brooten D,CampbellR,etal.Comprehensivedischargeplanningandhomefollow-upofhospitalizedelders:arandomizedclinicaltrial.JAMA:thejournaloftheAmericanMedicalAssociation1999;281:613-20.