Automated Hovering to Improve Medication Adherence Among Myocardial Infarction Patients (Heartstrong)
| Status: | Completed |
|---|---|
| Conditions: | Cardiology |
| Therapuetic Areas: | Cardiology / Vascular Diseases |
| Healthy: | No |
| Age Range: | 18 - 80 |
| Updated: | 12/15/2017 |
| Start Date: | March 2013 |
| End Date: | June 2017 |
The goal of this proposal is to test the implementation of an innovative approach to
improving health and lowering cost for a high risk population of patients with acute
myocardial infarction (AMI) immediately post-hospitalization. The investigators will
implement a new service delivery approach that will provide a foundation for a payment system
that rewards keeping high-risk patients healthy and that deploys technology and a health care
workforce of the future to implement prevention, care coordination, care process
re-engineering, team-based care, and the use of data to support new care delivery models.
This program is focused on coronary artery disease (CAD), but we expect that a successful
implementation of this model will demonstrate a sustainable pathway to the three-part aim not
just for CAD, but for many other conditions whose outcomes are highly sensitive to
post-discharge coordination.
This proposal has three main principles:
1. Principles of behavioral economics that have been developed, refined, and tested over
the past decade offer practical insights into health behaviors that were previously
unavailable and are not reflected in existing care models.
2. New technology, typically wireless devices for pill bottles, and mobile telephones, make
engagement with patients substantially easier and more immediate now than ever before.
3. While randomized clinical intervention trials provide exceptional confidence of
comparative effectiveness in narrow interventions, they are slow and rigid and dont
reflect the urgency that health care transformation currently requires. Principles of
rapid cycle innovation are gaining acceptance as an alternative to or supplement of
these traditional methods in supporting evidence for implementation success.
improving health and lowering cost for a high risk population of patients with acute
myocardial infarction (AMI) immediately post-hospitalization. The investigators will
implement a new service delivery approach that will provide a foundation for a payment system
that rewards keeping high-risk patients healthy and that deploys technology and a health care
workforce of the future to implement prevention, care coordination, care process
re-engineering, team-based care, and the use of data to support new care delivery models.
This program is focused on coronary artery disease (CAD), but we expect that a successful
implementation of this model will demonstrate a sustainable pathway to the three-part aim not
just for CAD, but for many other conditions whose outcomes are highly sensitive to
post-discharge coordination.
This proposal has three main principles:
1. Principles of behavioral economics that have been developed, refined, and tested over
the past decade offer practical insights into health behaviors that were previously
unavailable and are not reflected in existing care models.
2. New technology, typically wireless devices for pill bottles, and mobile telephones, make
engagement with patients substantially easier and more immediate now than ever before.
3. While randomized clinical intervention trials provide exceptional confidence of
comparative effectiveness in narrow interventions, they are slow and rigid and dont
reflect the urgency that health care transformation currently requires. Principles of
rapid cycle innovation are gaining acceptance as an alternative to or supplement of
these traditional methods in supporting evidence for implementation success.
The specific aims of this study are to:
1. Test the effectiveness of a state-of-the-art web-based portal with home-based wireless
medication adherence devices and behavioral economic feedback mechanisms in preventing
vascular events or re-hospitalization in the 12 months following hospital admission for
AMI
2. Deploy a new model of evidence based evolutionary learning that uses rapid cycle
innovation in 3 successive planning cycles over the 36 months of this proposal
Patients will be randomized into 1 of the 2 study groups.
1. The control group will have their health insurance claims records analyzed over a 12
month period for comparison to the participants in the intervention arm.
2. The intervention group:
(1) will use the GlowCaps, a remote monitoring and reminder pill bottle; (2) will be assigned
an engagement advisor from the study team; (3) be asked to provide the study team with names
and contact information of up to 3 family members or friends as support partners for
medication adherence; (4) will be eligible for daily sweepstakes-based engagement incentives
in which eligibility to win will be conditional on medication adherence; (5) can choose to
modify their preferences for Way to Health platform communication methods during the study.
The group receiving the program intervention will also have their claims data analyzed for
the 12 months post-enrollment.
1. Test the effectiveness of a state-of-the-art web-based portal with home-based wireless
medication adherence devices and behavioral economic feedback mechanisms in preventing
vascular events or re-hospitalization in the 12 months following hospital admission for
AMI
2. Deploy a new model of evidence based evolutionary learning that uses rapid cycle
innovation in 3 successive planning cycles over the 36 months of this proposal
Patients will be randomized into 1 of the 2 study groups.
1. The control group will have their health insurance claims records analyzed over a 12
month period for comparison to the participants in the intervention arm.
2. The intervention group:
(1) will use the GlowCaps, a remote monitoring and reminder pill bottle; (2) will be assigned
an engagement advisor from the study team; (3) be asked to provide the study team with names
and contact information of up to 3 family members or friends as support partners for
medication adherence; (4) will be eligible for daily sweepstakes-based engagement incentives
in which eligibility to win will be conditional on medication adherence; (5) can choose to
modify their preferences for Way to Health platform communication methods during the study.
The group receiving the program intervention will also have their claims data analyzed for
the 12 months post-enrollment.
Inclusion Criteria:
- Patients admitted to hospitals throughout New Jersey or at the University of
Pennsylvania Health System who are discharged (or scheduled to be discharged) to their
homes with a principal or secondary diagnosis code of International Classification of
Diseases, 9th Revision, Clinical Modification (ICD-9-CM) 410 (except when the fifth
digit was 2)
- a length of stay of 1 to 180 days
- Aged 18 to 80 years
- Be discharged to home
- Prescribed at least 2 of these 4 medication categories (statin, aspirin, beta-blocker,
anti-platelet)
Exclusion Criteria:
- cannot give consent
- have a markedly shortened life expectancy (diagnosis of metastatic cancer, end-stage
renal disease on dialysis, or dementia)
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