Virtual Care for Specialty and Chronic Care
Two groups of patients who need frequent monitoring are post-lung transplant patients to detect and prevent chronic rejection, and those who live with inflammatory bowel disease (IBD) to detect and treat flares. While monitoring their health is crucial, it is expensive, time intensive, involves travel, and also takes up capacity of patients who may have more urgent needs.
In their presentation “Virtual Care for Specialty and Chronic Care” at the UC 2021 Telehealth Summit, Anobel Odisho, M.D., M.P.H., Associate Professor of Urology, and Olivia Bigazzi, Product Manager, both at UCSF’s Center for Digital Health Innovation (CDHI), talked about the virtual digital innovation they are working on that helps improve the patient and provider experience.
Following are some highlights:
Lung Virtual Chat Program
As post-lung transplant patients are immunocompromised, traveling was risky for them during the pandemic. To enable monitoring, the Lung Transplant Program and the Digital Patient Experience Program collaborated to launch the lung virtual chat program and home spirometry kit for patients.
The team carried out different experiments to enroll patients. Initially, five patients were handpicked, then patients were allowed to self-enroll, and once the program was stable, it was released widely.
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Currently, 479 patients are enrolled in the program; 73% have engaged with the chat
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66% submitted remote monitoring data at least once
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50% continue to engage even a year after the program
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Men and non-English speakers were less likely to engage
Since its launch in May 2020, the team found that the home spirometer can be as effective and accurate as replacing some pieces of the in-lab pulmonary function tests. Six in-person clinic and lab visits are also eliminated for patients during the first two-years post-transplant.
According to Odisho, if these continue to be replaced for patients who are doing well, then providers can see patients who require more attention.
Inflammatory Bowel Disease Virtual Chat Program
At UCSF’s Colitis and Crohn’s Disease Center, about 2,500 patients are treated for IBD.
In the IBD Virtual Chat Program, patients are asked questions and given options to select from. Symptom scores are then calculated on the backend and assigned colored flags based on severity.
If patients need attention, their flags go to the clinic’s in-basket for providers to review and provide action.
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About 2,100 patients are enrolled
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Compared to the virtual lung chat program, engagement is slower at 38%, but the team attributes it primarily due to the fast rate of enrollment, and also that clinical patients are a different group
The DPE team is working with the clinic on automating follow-ups for patients who are doing fine, and creating appropriate documentation so that they can opt skipping visits. Currently, patients who are stable still need to come in every six months for documentation so that they are able to receive their medical refills and insurance authorizations.
Likewise with the virtual lung chat program, by eliminating visits, the goal is to open capacity for more new patients and those with more active symptoms.
While both programs are virtual, patient engagement is different for each of them and dependent on clinical conditions and sociodemographic factors.
Odisho and Bigazzi talked about the importance of integration with clinical workflows and practice patterns to enable operational efficiencies. They’re also building feedback loops in the programs so that patients have trust that remote care is part of their “usual care.”
For more information about CDHI digital innovation and solutions, visit www.centerfordigitalhealthinnovation.org