Use of Patient Buddy™ Application to Disseminate Knowledge & Prevent Readmission

Cirrhosis affects more than five million patients in the United States. Patients can develop complications such as hepatic encephalopathy (HE), variceal bleeding, and infections, leading to costly and burdensome readmissions that may have been avoided with better communication among patients, caregivers, and clinicians. Due to patient cognitive dysfunction from the illness, caregiver involvement is essential to understanding disease complications, preventing medication-associated issues, and alerting staff early to manage outpatient issues.

Current methods of preventing readmissions are inadequate and reactive instead of proactive. Conversely, mobile health applications have the ability to reduce hospital admissions by disseminating vital health information to clinicians before a patient becomes critical. This project examined the feasibility of using the innovative Patient Buddy^TM Application (App) to connect patients with cirrhosis and their caregivers with clinicians. The app provides separate user interfaces for caregivers and patients and communicates readmission risk factors to a nurse manager. Researchers evaluated its impact on reducing readmissions in patients with cirrhosis within 30 days of discharge.

The specific aims of the project were as follows:

• To perform a pilot and feasibility study of disseminating current knowledge of readmission prevention in cirrhosis by using the Patient Buddy App with patient and caregiver interfaces. 
• To incorporate the opinion of key stakeholders (patients, caregivers, and nurse managers) towards improving the Patient Buddy App in the prevention of readmission for cirrhosis. 

Inpatients with cirrhosis and their caregivers were each given mobile devices with the Patient Buddy App. They were trained on entering medication adherence, daily sodium intake, vital signs, and weekly cognitive and fall-risk assessment. They also received education on cirrhosis-related symptoms. During the course of the study, Patient Buddy sent automatic alerts between patient or caregivers and the clinical team. After 30 days, data and HE-related admissions were analyzed, as well as the feasibility of using the app and its usability. Results indicated that of the 40 participants, eight potential HE-related readmissions were prevented through app-generated alerts that encouraged early outpatient interventions and communications with clinical staff. Of the 17 patients who were readmitted within 30 days, none were for HE, which is the most common and preventable cause for readmission. User testing indicated that some patients found the data entry requirements to be too demanding, but the majority found it to be useful for its educational value. This proof-of-concept trial found the use of Patient Buddy to be feasible in recently discharged patients and caregivers.