A Web-Based, Provider-Driven Mobile App to Enhance Patient Care Coordination Between Dialysis Facilities and Hospitals: Development and Pilot Implementation Study

Abstract

Background We piloted a web-based, provider-driven mobile app (DialysisConnect) to fill the communication and care coordination gap between hospitals and dialysis facilities. Objective This study aimed to describe the development and pilot implementation of DialysisConnect. Methods DialysisConnect was developed iteratively with focus group and user testing feedback and was made available to 120 potential users at 1 hospital (hospitalists, advanced practice providers [APPs], and care coordinators) and 4 affiliated dialysis facilities (nephrologists, APPs, nurses and nurse managers, social workers, and administrative personnel) before the start of the pilot (November 1, 2020, to May 31, 2021). Midpilot and end-of-pilot web-based surveys of potential users were also conducted. Descriptive statistics were used to describe system use patterns, ratings of multiple satisfaction items (1=not at all; 3=to a great extent), and provider-selected motivators of and barriers to using DialysisConnect. Results The pilot version of DialysisConnect included clinical information that was automatically uploaded from dialysis facilities, forms for entering critical admission and discharge information, and a direct communication channel. Although physicians comprised most of the potential users of DialysisConnect, APPs and dialysis nurses were the most active users. Activities were unevenly distributed; for example, 1 hospital-based APP recorded most of the admissions (280/309, 90.6%) among patients treated at the pilot dialysis facilities. End-of-pilot ratings of DialysisConnect were generally higher for users versus nonusers (eg, “I can see the potential value of DialysisConnect for my work with dialysis patients”: mean 2.8, SD 0.4, vs mean 2.3, SD 0.6; P=.02). Providers most commonly selected reduced time and energy spent gathering information as a motivator (11/26, 42%) and a lack of time to use the system as a barrier (8/26, 31%) at the end of the pilot. Conclusions This pilot study found that APPs and nurses were most likely to engage with the system. Survey participants generally viewed the system favorably while identifying substantial barriers to its use. These results inform how best to motivate providers to use this system and similar systems and inform future pragmatic research in care coordination among this and other populations.

Effectiveness of a Web-Based Provider Communications Platform in Reducing Hospital Readmissions Among Patients Receiving Dialysis: A Pilot Pre-Post Study

“…Fidelity to the intervention was suboptimal; although most hospital admissions were captured in the system, the number of users engaged with DialysisConnect was low, even among some of the most critical roles for care transitions (eg, dialysis nurses and social workers). 19 Most, but not all, inpatient care for Emory Dialysis patients occurs at EUHM; we were not able to track inpatient admissions or other hospital utilization outside of EUHM, and this potential loss to follow-up may have been greater among other dialysis patients admitted to EUHM. Although, loss to follow-up because of mortality could lead to selection bias, sensitivity analyses showed that results were not substantially changed with the exclusion of discharges followed by mortality within 30 days.…”

“…18 To address this gap, we introduced "DialysisConnect," a secure, web-based, 2-way communications platform that allowed direct communication between providers, automated messages at admission and discharge, and timely exchange of critical discharge information (Fig S1). 19 The system was available to physicians, advanced practice providers, nurses, social workers, and other individuals as identified by the site champions. 19 We piloted Dialy-sisConnect at Emory University Hospital Midtown (EUHM) and 4 affiliated Emory Dialysis facilities.…”

“…19 The system was available to physicians, advanced practice providers, nurses, social workers, and other individuals as identified by the site champions. 19 We piloted Dialy-sisConnect at Emory University Hospital Midtown (EUHM) and 4 affiliated Emory Dialysis facilities. Despite the shared affiliation, EUHM and Emory Dialysis do not share health care management or an EHR, reflecting the typical situation at most US hospitals and dialysis facilities.…”