- Physicians at Cedars-Sinai Hospital are using an mHealth wearable to track and improve recovery times for post-operative patients.
In a program that began roughly one year ago, patients are given a Fitbit after undergoing major surgery to track their steps. The wearable not only helps doctors measure a patient’s movements; it helps motivate patients, often improving the recovery process and reducing treatment time (including days spent in the hospital).
“In the context of major surgery, ambulation is one of the most critical outcomes we focus on post-operatively,” says Timothy J. Daskivich, MD, a urologist at the Los Angeles-based health system and one of 10 clinicians involved in the program.
"Patients need to walk after they've had a surgery," Brennan Spiegel, MD, Cedars-Sinai’s director of health services research, recently told CNBC. "There's decades of research, so we know that."
But there are no standards or guidelines, Daskivich says, to measure ambulation.
“Universally, after major surgeries, ambulation is endorsed,” he says. “There’s the guideline.”
Daskivich and Spiegel decided to work on that. In their initial study, they measured patient activity and developed a baseline – 1,000 steps a day – for patients recovering from surgery. In another study, they’re developing feedback loops, enabling both patient and doctor to take that activity data and use it for care coordination and management.
“The idea is, well, how can we quantify this?” Daskivich says. “There are a lot of variables,” including the patient’s age and fitness going into the surgery and the type of surgery involved.
Fitbits are the device of choice in mHealth, with more than 500 studies published since 2012 (almost half of which have been done since 2017), according to the company’s research. More than 80 percent of clinical trials involving a wearable activity tracker have used Fitbits. But they’re not the only mHealth wearable, and they’re part of an mHealth ecosystem that looks to change how providers interact and treat their patients when they’re outside the hospital or doctor’s office.
Some healthcare providers have questioned whether step-tracking should be part of the medical record, since the process of tracking steps isn’t exact and the data gathered isn’t medical grade. But those using Fitbits and other types of wearables in clinical trials and pilot projects say the data can be used to set a benchmark, and to create a better means to measure activity and foster engagement.
“Providers … really want to have this type of information,” Adam Pellegrini, Fitbit’s vice president of digital health, told mHealthIntelligence.com in a December 2016 interview. “This is a very powerful educational [channel] that creates an awareness of how fitness and health play together.”
“The opportunity is there (for providers) to use consumerism, to tap into the power of the individual to affect change,” Amy McDonough, vice president and general manager of Fitbit Group Health, added in a separate interview. “The results we’re seeing are not only (showing) cost savings, but improving clinical outcomes as well.”
“They’re looking for general trends, not accuracy,” says Jodi Daniel, who directed the consumer e-Health program for the Office of the National Coordinator for Health Information Technology and was the ONC’s director of the Office of Policy. “That data definitely does have meaning, if it’s used the right way.”
Among those clinical outcomes is a reduction in treatment time and fewer adverse events, such as rehospitalizations.
Tracking and encouraging activity after major surgery can have a positive impact on the patient’s recovery time, thereby improving clinical outcomes and reducing treatment expenses.
In a 2017 study published in the Annals of Behavioral Medicine, researchers at the University of Pittsburgh Cancer Institute saw a reduced risk of rehospitalization in patients undergoing cancer surgery after they were given Fitbits and encouraged to measure their activity.
The study – the first to link activity tracked by a wearable to readmission rates - also enabled clinicians to identify patients most at risk of developing complications, so that additional monitoring and intervention could be prescribed. This, in turn, reduced adverse events and the healthcare costs associated with them.
New York’s Memorial Sloan Kettering Cancer Center and Boston’s Dana-Farber Cancer Institute have both used Fitbits to track activity in patients undergoing cancer treatment and to help motivate them to achieve health and wellness goals.
Cedars-Sinai has also used Fitbits in this manner. In a small study launched in 2016, they used the wearable to track activity in patients undergoing chemotherapy.
“What we know is that individuals who are up and about tend to be more able to tolerate chemotherapy and have a greater potential for benefitting from it,” lead investigator Arvind Shinde, MD, of the departments of supportive care medicine, hematology, and oncology, told HospiMedica.com. “People who are spending more time in bed usually get harmed by the treatment we give, even if the cancer is responsive to the treatment.”
Daskivich says this latest project aims to quantify the concept of activity.
“We ask patients how much they walked and we take their answer at face value,” he says. “Now we can measure that.”
But it’s also a means of promoting a connection between doctor and patient, and nudging the patient to be more active in his or her recovery. Spiegel – who authored a recent study that indicates mHealth devices and sensors haven’t yet proven their ability to affect clinical outcomes – says the work they’re doing is as much about collaboration as it is about data.
"We can't lose the humanity by overly relying on the zeros and ones that come off these sensors," he said in a press release recently issued by Cedars-Sinai. "The key is perfecting how doctors and patients work together in the very human science of medicine, and improve shared decision-making with assistance of technology. It's not one or the other."
Daskivich says he’s surprised and encouraged by the enthusiasm shown by patients using the Fitbits. That has spread to the doctors involved in the program, who are seeing positive results in a project that, quite simply, measures steps.
“The best interventions in healthcare are ones that align common goals,” he points out.