Virtual Patient Advocate Could Enhance Health Literacy

Researchers at Boston Medical Center (BMC) are investigating whether a virtual patient advocate can improve real-life health literacy.

Developed by Timothy Bickmore, PhD, assistant professor of computer and information science at Northeastern University in Boston, the virtual patient advocate is on clinical trial at BMC to increase patient understanding of post-discharge self-care regimens. Bickmore and his team of researchers hope the system can decrease patient readmissions within 30 days of hospital discharge.

"Nationally it's been shown that about 20% of patients get readmitted within 30 days," says Bickmore, who adds that a third of that percentage are preventable. "There is a lot of information patients need to know before they go home. The typical discharge in the U.S. lasts about eight minutes and it's like 'here are your prescriptions and a pat on the back.'"

According to the U.S. Department of Education's 2003 National Assessment of Adult Literacy, 36% of the U.S. adult population has only basic or below basic health literacy levels. And while the virtual patient advocate doesn't have a medical or nursing degree, or even a pulse, she can provide patients with the information they need to know—via a computer. She can also devote all of her time to doing so.

The system operates by having a clinical trial nurse enter a predischarge patient's information into a computer database. This generates an "After-Hospital Care Plan" personalized booklet for the patient. After that, the nurse wheels the computer to the patient's bedside on a kiosk and gives the patient his or her pamphlet. The patient then converses with an animated virtual patient advocate character using a touch-screen display to go over their care instructions.

The system enables the patient to review his or her medication list, follow-up appointments, primary diagnosis, pending lab tests, medical durable equipment needed at home, and diet and exercise recommendations. It also creates a list of questions the patient can review with a nurse at the end of the interaction.

In addition, the pamphlet features a patient activation page that encourages patients to write down questions and issues they may want to discuss with their primary care physician prior to the actual visit.

To date, 220 patients have participated in the three-year clinical trial of the virtual patient advocate that began at BMC in fall 2008, which will conclude after enrolling 750 patients. These patients are getting 40 minutes on average and sometimes more than an hour, depending on the number of medications they are taking, to go over their care instructions, says Bickmore.

Researchers have already compiled data showing that low health literacy patients find the system user-friendly, and sometimes even preferable to receiving the information from a physician or nurse.

"What I find most helpful is the ability of the virtual patient advocate to drill down to patients' concerns," says Lynn Schipelliti, RN, who is participating in the study at BMC. "I see it as an asset to healthcare. Patients are going home sicker and have multiple medical problems to manage at home. Talking about discharge when patients are admitted allows them time to think beyond today and what it will be like when they go home."

Ultimately, it is the human-like nature of the virtual patient advocate that seems to increase the effectiveness and understanding of patients' care plans.

"The virtual patient advocate is patient and kind, shows empathy and humor, has medical knowledge, and shows confidence. All of these things make her believable and trustworthy to patients," Schipelliti says. "They appreciate the private time they are allowed to listen and ask questions—and that they decide when they have had enough."

The research for the virtual patient advocate is sponsored by a grant from the National Heart, Lung, and Blood Institute of the National Institutes of Health.