Use of Mobile Technology to Improve Acute Care Utilization in Sickle Cell Disease Abstract Sickle cell disease (SCD) is a chronic illness associated with frequent medical complications and hospitalizations. Importantly, approximately 90% of acute care visits are for pain events, and 30-day re-utilization rates are alarmingly high. While factors influencing these high re-utilization rates are poorly understood, close follow up and continued titration of pain medications has been shown to decrease re- hospitalization rates. Mobile technology has become an integral part of health care management. We have recently developed SMART (Sickle cell Mobile Application to Record symptoms via Technology) to assist with documentation of pain and interventions. We propose using this innovative mobile technology application to aid self-monitoring and health self-management by offering both patients and providers the tools to monitor as well as manage symptoms and health interventions. We believe this technology will lead to a significant decrease in rates of 30-day acute care re-utilization and overall disease burden. We will thus test the central hypothesis that SMART will allow personalized therapy based on daily assessments, ultimately reducing acute care utilization. This hypothesis will first be tested in the context of a single institution Day Hospital/Infusion Center for patients with SCD Aim 1: Determine acute care utilization for patients given SMART following treatment at our Day Hospital. Acute care utilization will be defined as hospital admission, emergency department (ED) visits, or return to the Day Hospital. Patients seen at the Day Hospital for pain crisis will be approached and given SMART to use for 30 days. Patients will use SMART to record daily pain scores and any interventions taken. Geo-fence technology will inform providers of admission to Day Hospital, ED, or hospital. In addition to providing standard algorithms to guide treatment, patients will receive individualized therapy recommendations based on daily review of data by the provider team.
Aim 2 : Document compliance using SMART to the treatment plan specified by the provider team for medications and follow up appointments. Upon discharge from an acute care visit, specific instructions are given to the patient to continue therapy for their ongoing pain. Provider instructions will be programmed into SMART and reminders to take medications and timing of follow up visits will be given to patients via their smartphone. The use of SMART to provide individualized therapy plans based on daily assessment of pain will be critical in reducing acute care utilization rates i patients with SCD. Future plans include multicenter studies of the long- term use of SMART for guided therapy, medication compliance and improving quality of life.
Greater than 50% of patients with SCD are admitted following an acute care visit to the Day Hospital. This application will evaluate the use of a novel smartphone application to record symptoms, interventions, and medication compliance. We aim to reduce acute care visits through continuous monitoring to give instant recommendations through computerized algorithms and review of patient data by the care team.
