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

• Type of Material: Article
• Authors: Laura Plantinga, Emory University; Courtney Hoge, Emory University; Ann Vandenberg, Emory University; Kyle James, Emory University; Tahsin Masud, Emory University; Anjali Khakharia, Emory University; Carol Gray, Emory Healthcare; Bernard G Jaar, Johns Hopkins School of Medicine; Janice Lea, Emory University; Christopher O'Donnell, Emory University; Richard Mutell, Apex Health Innovations
• Language: English
• Date: 2022-06-01
• Publisher: JMIR Formative Research
• Publication Version: Final Published Version
• Copyright Statement: ©Laura C Plantinga, Courtney Hoge, Ann E Vandenberg, Kyle James, Tahsin Masud, Anjali Khakharia, Carol Gray, Bernard G Jaar, Janice P Lea, Christopher M O'Donnell, Richard Mutell. Originally published in JMIR Formative Research (https://formative.jmir.org), 10.06.2022.
• License: Creative Commons Attribution 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.2196/36052
• Title of Journal or Parent Work: JMIR Formative Research
• Volume: 6
• Issue: 6
• Start Page: e36052
• End Page: e36052
• Grant/Funding Information: The research reported in this publication was supported by the National Institute of Diabetes and Digestive and Kidney Diseases of the National Institutes of Health under award number R18DK118467. The content is the sole responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.
• Keywords: physicians; dialysis; nurses; advanced practice providers; hospitals; care coordination; mobile app
• Research Categories: Health Sciences, Epidemiology; Health Sciences, Medicine and Surgery

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.