Using Telehealth to Enable Patient-Centered Care for Liver Transplantation.

What Is the Innovation? Liver transplantation is a highly complex and resource-intense intervention. Patients are often significantly debilitated, have a poor nutritional state, and incur the comorbidities of chronic immunosuppression. These realities leave recipients at high risk for complicationsandsubsequent rehospitalization.Atour institution, the30day readmission rate following liver transplantation is 42% and increases to69%at 1 year.1 This rate is similar tonational 30-day readmission rates of 40%, andmore than 20%of these patients are readmittedmultiple times, with readmissions accounting formore than 10% of combined 90-day direct costs.2 Clearly, this is an area in which we as a community must improve. To address this issue, we are currently piloting a patientcentricmodelofacuteposttransplantationsurgical andmedical care. Throughatablet-basedmonitoringandfeedback infrastructure, telehealth will be used to support patients and caregivers and to improve their communication with health care professionals. Although use of telehealth has gained momentum in the medical community, it has not yet been well adopted in the surgical community. Duringthedevelopmental stage,asurveywasconductedamong transplantation candidates toassess technological literacy andwillingness to adopt a tablet monitoring system into their postoperative care. In total, 159 surveyswerecollected,withmostpatients reportinguseof the Internet (70.8%)andemail (73.8%),while almost half of the patients (45.6%) reported having used a smartphone or tablet computer. Almost 90%of patients reported being comfortableusingelectronicmonitoringandcommunicationduringtheposttransplantation period. In addition, 77.1% of patients thought that it would be helpful for postoperative care. Eligiblepatientsareenrolledat thetimeof transplantsurgeryadmission. On discharge, patients receive a tablet containing automatedtextmessagesspecifictotheirpostoperativestatus,dailyhealth questions, anda configuredvital sign trackingprogram fromremote devices to include temperature, bloodpressure, bloodglucose level, and weight measurements. The tablets are also equipped with videoconferencing ability to allow for patient and health care professional interface (Figure). Objectivemeasures, including alerts, timeliness of responses, and data inputs, are tracked by the transplant team.Thisprotocol isdesignedtoaddressacutepostoperativeneeds after transplantation, andpatientswill participate for90days.Using thesedata,thetransplantteamwillbeabletocloselymonitortheprogress of the recipients during their initial at-home days. In addition to reported patient data, health services utilization is tracked, including calls, clinic visits, and health care professional satisfaction.This informationwill beusedtoevaluate the impact that suchaprogramwillhaveonresourceutilizationandpatientandcaregiver satisfaction. Long-termendpoints of analysiswill include 30day and 90-day readmission rates, outpatient clinic visits, and recipient health metrics such as blood glucose level, blood pressure control,medicationadherence,weight lossorgain,andactivitygoals. The pilot study has successfully enrolled 20 of 23 eligible patients.Threepatientswerenotenrolleddue todeath, refusal, or lack of long-termevolution coverage at the place of residence. Because of theongoingnatureof thispilot study,preliminarydataarenotyet available but are expected by the fall of 2015.