Smart Phone Apps + Health Coach = Better Surgical Outcomes, Says UPMC

A digital platform developed at UPMC helps patients prep for surgery and speeds recovery.

Linking a health coach with a smart phone app providing perioperative instructions dramatically improves post-surgery recoveries and reduces readmissions, a new study from UPMC and University of Pittsburgh School of Medicine shows.

The research, published this week in the Journal of Medical Internet Research, shows that patients who used the Pip Care digital platform – an app created through UPMC Enterprises - had hospital stays that were nearly one day shorter than patients who did not, and that readmissions were cut in half in the week post-discharge. 

While numerous studies have already shown that surgical outcomes are better when patients comply with perioperative instructions, the study authors note that "ensuring that adherence is easier said than done."

"Verifying that this hybrid digital-telemedicine platform is both easy for patients and clinicians to use and significantly improves patient outcomes and satisfaction with surgery is a welcome clinical advance," says senior author Aman Mahajan, MD, PhD, chair of the Department of Anesthesiology and Perioperative Medicine at Pitt.

Several mobile apps have been launched over the past few years with varying success. The UPMC researchers say that Pip Care is the first to couple a digital platform with one-on-one telehealth coaches who check in with patients and coordinate care. 

Pip Care connects with surgery patients early in the "prehabilitation" stage a month or so before their procedures and offers advice on nutrition, physical conditioning, psychological support, and quitting smoking. The app breaks down presurgical instructions into easy-to-understand daily tasks and the care coaches answer questions and keep patients accountable. Pip Care also coaches patients post-surgery, helping them understand discharge instructions, wound care and pain management.

Study lead author Stephen Esper, MD, associate professor of anesthesiology and perioperative medicine at Pitt, director of the UPMC Center for Perioperative Care, and an advisor at UPMC Enterprises, says prepping for major surgery is like prepping for a marathon.

"If you want to perform your best, you don't just show up and run. You have to train first and get your body ready for the stress," Esper says. "It's similar with surgery – by optimizing your health beforehand, you have a better recovery."

Methodology

Researchers compared 128 Pip Care patients who were scheduled for elective abdominal, spine or total joint replacement surgery to 268 peers scheduled for the same surgeries at the same hospitals who did not use Pip Care. The Pip Care patients were enrolled about two to four weeks before surgery and continued using it through four weeks after surgery.

On average, Pip Care patients remained hospitalized after surgery for 2.4 days, while non-Pip patients stayed for 3.1 days. Pip Care patients had a 49% lower risk of being readmitted to the hospital within a week of discharge, compared to their non-Pip counterparts. 

The patients who received Pip Care averaged 6.7 sessions with their digital health coach, with 82% attending sessions at least once a week. In follow-up surveys, patients reported high – 4.8 out of 5 points – scores for satisfaction with the app. 

"Many health systems are facing considerable staff shortages and one of the consequences is that clinical teams, who are dedicated to their patients' success, have limited time to provide focused, patient-specific surgical optimization," says Mahajan, who is also senior vice president of health innovation at UPMC Enterprises.

"By partnering with health systems and hospitals Pip Care is providing patients a sense of connection and a better understanding of their surgical journey, prompting them to actively engage in their health and those patients have better surgical outcomes."