Background: Heart failure (HF) hospital readmissions are a leading cause of US 30-day hospital readmissions. Factors related to clinical complexity and unmet social needs are among the key drivers associated with HF negative clinical outcomes. Digital platforms have shown promise in improving HF outcomes but limitations like patient lack of familiarity with technology and unmet social needs continue to limit implementation and adoption. Hypothesis: An intervention pairing HF patients with a digital platform and a community health worker (CHW) for 30 days post-hospital discharge is (a) feasible, (b) acceptable, and (c) can demonstrate preliminary effectiveness in reducing 30-day hospital readmissions, emergency department (ED) visits, and missed clinic appointments compared to control (CHW only).
Methods: Adult inpatients at high risk for readmission were enrolled in a randomized controlled trial September 2022 – June 2023 (N=50). The 30-day intervention used a digital platform within a mobile phone application that included a daily symptom questionnaire and HF educational videos connected to a biometric sensor (tracking heart rate, oxygenation, steps taken), a digital weight scale, and a digital blood pressure monitor. All patients were paired with a CHW with dashboard access to the digital platform. CHWs were trained further orient patients t the platform, resolve basic technical issues, and monitor the dashboard with the use of a color-coded schematic ( green-yellow-red) associated with a daily score indicating if patients were at or moving away from their clinical baseline. Feasibility outcomes (use of the platform and CHW), acceptability outcome (willingness to use the intervention again), and preliminary effectiveness outcomes (30-day readmissions, emergency department (ED) visits, and missed PCP/specialty appointments) were analyzed.
Results: Analysis demonstrated intervention feasibility with participant wear of the sensor (11.1 hrs/day (mean), use of the digital blood pressure (1.0 times/day; SD=0.22) and weight scale (1.1 times/day (SD=0.18) . The symptom questionnaire was completed on 78% of study days (mean) and ≥2 CHW interactions occurred for 76% of participants. Acceptability was also demonstrated with 91% of participants indicated willingness to use the intervention again. A ~15% absolute reduction in 30-day readmissions was noted (14% vs. 29%), with a reduction in missed appointments (0% vs. 3%) in the digitally-enabled CHW vs. CHW enhanced usual care arm. No reduction in ED visits was seen. The most common CHW-patient interactions included healthcare coaching (23%), psychosocial support (21%), reinforcement of the care plan (21%), and making appointments (7%).
Conclusions: This trial demonstrates the feasibility, acceptability, and preliminary effectiveness of a digitally-enabled CHW intervention for patients with heart failure in a pilot trial. Though this was a small studyl inadequately powered to assess clinical outcomes or true effectiveness, the novel intervention demonstrates promise and seeks to enhance clinical care by re-enforcing clinical care plans, addressing unmet needs related to social determinants of health, and providing biometric data to care teams to detect clinical decline earlier and potentially prevent readmission. A larger randomized controlled trial is needed to establish the effectiveness of this intervention on clinical outcomes like 30-day readmission.