Triumph: Engage Family Caregivers for Frail Seniors
SUMMARY
Background
Community-based senior care programs are built to keep seniors living comfortably in their homes. Health disparities result in people of color having less access to and quality of care in the home.
A population of 125 seniors of color managed by an inter-disciplinary care team was selected to pilot the Care3 mobile app to measure impact of coaching family caregivers on care delivered at home. Success metrics focused on engagement, utilization, care team and family satisfaction, and outcomes.
Results
Patients and families using Care3 reported 5% fewer Level 2 falls per month versus previous year data. This fall reduction decreased costs by 9% due to fewer emergency visits and subsequent hospitalizations
There is an opportunity to use mobile apps to coach family on care delivered at home to reduce health disparities.
“The CareThree team with the Care3 technology platform has truncated the provision of service, the communication of that service to patient and family, and the documentation of that service down from days to minutes.”
carethree ENGAGEMENT
A large Senior Care Services provider (AltaMed) engaged carethree in a 7-month, 3-phase pilot to test the impact of the Care3 mobile app as a communication bridge between family caregivers and an interdisciplinary care team. A population of 125 higher-risk patients (all people of color) managed by an interdisciplinary care team was selected for the pilot. None of the chosen patients were receiving professional home care services. A total of 149 people including patients, family caregivers, and care team staff participated in the pilot.
Outcomes measured were plan adherence, interactions on platform (text, media, activities), Level 2 falls, emergency visits, and hospitalizations.
Each member of the care team and patient family caregivers downloaded and installed the Care3 mobile app (iTunes or Google Play) for their language (English, Spanish, or Chinese). Second, the care team accessed the web-based Care3 Action Planner from a web browser on their company notebook computers.
CareThree Health Information Coaches trained care team members on the web-based Care3 Action Planner module for planning care delivery as well as mobile app features. Care3 Health Information Coaches also trained family caregivers on the mobile app features and the information they would be collecting and reporting to the care team.
Care3 Action Planner was used by the care team to create detailed Action Plans of tasks for the patient families to complete at home. The care team and patient families used the Care3 mobile app for coaching about and tracking delivery of patient care. Each care task was sent to the caregivers as an Action Message on the Care3 mobile app. The Care3 mobile app automated reminders for when a task was to be done (which included care instructions), and tracked the completion of a task. Each month (and as needed), Care3 Health Information Coaches interacted with care team and patient families to answer technology and information questions.
RESULTS & CONCLUSIONS
The Pilot success metrics focused on engagement (onboarding and messaging), utilization (confirmed action task completion), care team and patient family satisfaction, and clinically relevant outcomes. Engagement and satisfaction were measured in all Phases, utilization was measured in Phase 1 and Phase 3 only, and clinical outcomes were aggregated across all Phases.
Activity Outcomes
In Phase 1, 80% of the participants were fully engaged on Care3. The ratio of reported completed actions (tasks) decreased over the three months. Some patient families stated that they could not find the “done” button to indicate task completion. These families reported task completion using text messages (unstructured) rather than the preferred method of tapping the “done” button (structured).
Monthly text messaging increased 46% in Phase 1 indicating Care3 is an effective means of communication and coaching between the care team and patient families and supplemented reporting of completed tasks. All medication refill requests were given via the Care3 mobile app by the end of Phase 1 throughout the remainder of the pilot’s duration.
In Phase 2, Action Plans were not sent to patient families so Care3 could build features to enhance care team collaboration in planning and reduce the problem of underreporting task completion. The pilot participants were allowed to continue using the Care3 mobile app for texting. Overall, text messaging dipped initially but increased to almost Phase 1 levels by the end of Phase 2.
In Phase 3 (one month), action plans resumed. Total Actions equaled the three months of Phase 1 combined. Actions were completed at a 53% higher rate than in Phase 1 (52% vs. 34%), indicating features created to address underreporting were successful. The 52% completion rate in Phase 3 quantifies the impact of coaching on patient family care delivery.
Use of Care3 for messaging accelerated in June 2018 by 16% month-over-month. This is a strong indication of satisfaction among care team users.
Clinical Outcomes & Financial Impact
Patients and families using Care3 reported 5% fewer Level 2 falls per month than those not using Care3 and versus previous year data. This reduced fall reduction decreased costs by 9% due to fewer emergency visits and subsequent hospitalizations.
Other Impacts
Senior care program staff also perceived (i.e., not formally measured) reduced inbound call volume and fewer emails from patient families in the pilot. care team members believed they were able to respond more quickly via texting on Care3 than if they had to respond via phone or emails. Further study with endpoints focused on time metric improvements could confirm these perceptions.
Conclusions
Based on measured results, the carethree team achieved the pilot objectives. The Care3 technology platform improved the efficiency, frequency, and clarity of communication between the care team and patient family caregivers for care delivered in the patient’s home for their families of color.
Results from the pilot program also indicate that the Care3 mobile app provided a convenient means of coaching between care team staff and pilot patient families. According to care team staff, text messaging conversation topics with patient families included family support, care task completion, and medication refills—all of which are important to engage family on care delivered at home.
Furthermore, our carethree team successfully measured that only 52% of the recommended care tasks to be delivered in the patient’s home were being completed. Armed with this data, the senior care program has the opportunity to respond in real-time to potentially avoid costly emergency visits and hospitalizations. This data will also help the senior care program customize and streamline the activities for home completion, choosing the most impactful care tasks that best support the overall care plan while managing caregiver burden.