App Assists Patients Decide if In-Home Hospital-Level Care is Right for Them

“Hospital at Home” may be underutilized

For a subset of patients experiencing acute illness that requires inpatient hospitalization, receiving hospital-level care at home may be a safe and effective option.

Research has shown that the Hospital at Home care model can provide high-quality care at a significant reduction in cost. However, there is a narrow window of time to identify patients who would benefit from such care. In addition, it is often difficult to effectively communicate unfamiliar care options to patients in the busy hospital environment, leading to underutilization of Hospital at Home.

Bringing data to the point of care for decision making

Two Wake Forest University researchers, Dr. Marc Kowalkowski, associate professor of Hospital Medicine and associate director of the Center for Health System Sciences, and Dr. Andrew McWilliams, a clinical associate professor of Internal Medicine, examined the problem. They tested whether technology might help patients and their families evaluate whether the Hospital at Home option is best for them. The researchers created a web-based app that aggregates necessary patient health information and delivers it to patients in an interactive way. This empowers patients and their families to make care decisions with their doctor. For the study, the team focused on patients with pneumonia—an illness that commonly results in hospital admission, although for the right subset of patients, could be treated safely at home.

“Being able to integrate data and view it at the point of care where it can actually be useful to inform care decisions in real time is something that wasn’t previously possible.” – Dr. Marc Kowalkowski

The app was dubbed 4PACS, short for “Partnering Patients and Providers for Personalized Acute Care Selection.” It can be accessed via tablet, smartphone, or computer. The researchers used mixed methods to iteratively design and test 4PACS, first talking with patients, caregivers, and providers to hear what they would want and need from the app. Next, the team created the 4PACS app in collaboration with these end users by conducting participatory design sessions and usability tests. The app was then tested and refined based on feedback. Everything from the flow of information to button size was reshaped based on user input.

The 4PACS app that was ultimately developed included interactive features to promote increased knowledge of Hospital at Home as a care option for patients with pneumonia. These features included an initial assessment of home-based eligibility factors (e.g., access to a working phone, food availability, ability to perform daily activities, or someone to help); side by-side comparison of Hospital at Home and traditional in-hospital care; interactive feature selection to discern preferences and values; answers to frequently asked questions; and a summary of responses in preparation for discussion with the care team.

An app to inform decision making

For the pilot study, the researchers examined the feasibility of using the app and its associated user experience. In both areas, overall feedback from app users was positive. Providers in particular found that the app helped patients prepare for a discussion about the Hospital at Home option.

Providers “were really positive about the potential impact of integrating this tool into their workflow to enhance their conversations with patients about the decision,” Dr. Kowalkowski said. “And the patients were, as we’d hoped, more prepared for that decision and had questions that were more relevant to the decision-making process.” The researchers are now evaluating ways to increase use of the app, evaluate it in a larger study, and determine whether it may be used for patients with other medical conditions.