Digital health tool cuts hospital length of stay for surgery patients

April 11, 2024 - A digital health platform that combines human health coaches and personalized recovery care plans was able to engage surgery patients in their perioperative journey and reduce their hospital length of stay (LOS), according to new research.

Published in the Journal of Medical Internet Research, the study examines the efficacy of Pip Care. The platform offers personalized surgical support, connecting users with certified health coaches who work closely with the patient’s surgical care team. The platform also provides a surgical recovery plan with daily tasks and advice.

UPMC partnered with Pip Care to test the platform's deployment. The study examined the platform's feasibility and acceptability and investigated the clinical outcomes and patient satisfaction associated with its use.

The research team from UPMC and the University of Pittsburgh School of Medicine invited patients scheduled for elective surgery to enroll in the digital health platform from about two to four weeks before their surgery through four weeks post-surgery. The patients were scheduled for surgery at an academic medical center between November 22, 2022, and March 27, 2023.

Researchers invited 283 patients to enroll in the platform, of whom 172 (60.8 percent) were enrolled. A majority of those who enrolled (83.1 percent) had one or more health coaching sessions. Among the patients who had at least one coaching session, 97.2 percent proceeded to surgery, which is an improvement from industry benchmarks of 90 percent to 93 percent, the study notes. After surgery, 70.3 percent of patients engaged with the platform.

Overall, the platform demonstrated an 82 percent weekly engagement rate, defined as repeat attendance at health coaching sessions. Results from 95 survey submissions showed high satisfaction with the platform. Patients strongly agreed that health coaching helped them through the perioperative process.

The researchers also compared 128 patients enrolled in the digital health platform to 268 peers scheduled for the same surgeries at the same hospitals who did not use the platform.

Patients using the platform experienced a 24 percent reduction in postoperative LOS. Pip Care users remained hospitalized for 2.4 days after surgery, while non-users stayed in the hospital for 3.1 days. However, users and non-users had similar 30-day emergency department return rates.

“Study after study has shown that patients are healthier and have better surgical outcomes when they adhere to a perioperative care plan – but ensuring that adherence is easier said than done,” said senior author Aman Mahajan, MD, PhD, the Peter and Eva Safar professor and chair of the department of anesthesiology and perioperative medicine at University of Pittsburgh School of Medicine, in a press release. “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.”

This is the latest example of digital healthcare enhancing the surgery care continuum.

A study published in 2022 showed that telehealth helped decrease no-show rates among surgical patients. The research team gathered data from the University of Alabama Birmingham between January 2018 and December 2021.

They created three groups: a historical control group of data from in-person visits between January 2018 and March 2020, a contemporary control group of in-person visits between March 2020 and December 2021, and a contemporary group of patients scheduled for telehealth visits between March 2020 and December 2021.

There were 553,475 total visits across the three groups, with an overall no-show rate of 11.3 percent. A multivariable-adjusted analysis of telehealth visits revealed that telehealth reduced the likelihood of a no-show by 79 percent.

As research showing the utility of telehealth in surgery grows, the American College of Surgeons has endorsed its use, releasing a statement highlighting the critical role telehealth can play in surgical care and outlining standards for using it.

According to the association, telehealth can improve access to surgical care by enabling patients in remote or underserved areas to participate in virtual consultations without traveling long distances. It also empowers patients to play an active role in their healthcare journey.