Real-Time Symptom Monitoring Using ePROS to Prevent Adverse Events During Care Transitions
Background
Adverse events (AEs) occur during 19-28% of care transitions, often leading to hospital readmissions and posing an ongoing threat to patient safety. Quickly identifying and addressing new or worsening symptoms is crucial, especially for patients for multiple chronic conditions (MCCs).
Leveraging digital health tools, such as mobile apps, to predict these events and enhance communication between patients, caregivers, and healthcare providers is an opportunity to mitigate AEs.
Study Goals
Our AHRQ-funded study aims to develop a mobile web app for patients transitioning home from the hospital. The app will collect patient-reported outcomes (PROs) and provide personalized AE risk assessments by integrating PROs with electronic health record (EHR) data.
We aim to develop and validate a model that predicts post-discharge AEs for MCC patients using PROs and EHR data. Our project will enhance existing digital health infrastructure to support real-time symptom monitoring. Using data exchange standards and APIs, our app will integrate with current patient portals to address current care gaps.
Our Approach
To ensure our app meets the needs of patients, caregivers, and clinicians, our multidisciplinary team will use user-centered design and agile development approaches. This will allow us to refine the intervention based on continuous feedback.
We will test this approach in a large multi-site randomized controlled trial, comparing it to usual care for MCC patients during their transition from hospital to home.
Results
We will conduct a thorough evaluation to establish best practices for implementing this intervention across various healthcare settings. Using PROs for real-time symptom monitoring during hospital transitions could transform patient care by empowering patients and improving post-discharge monitoring.
Dissemination
This study represents an innovative, user-centered approach to advance patient safety and care quality. Some preliminary findings have been presented at national and international conferences, including AMIA conferences and the PROMIS 2022 conference in Prague.
We look forward to sharing the results of our study and contributing to the development of effective interventions to reduce adverse events during care transitions.