Effect of a Short Message Service Intervention on Patients With Short Bowel Syndrome
| Status: | Terminated |
|---|---|
| Conditions: | Gastrointestinal |
| Therapuetic Areas: | Gastroenterology |
| Healthy: | No |
| Age Range: | Any - 18 |
| Updated: | 3/31/2019 |
| Start Date: | February 20, 2018 |
| End Date: | March 21, 2019 |
The investigators will be using a text messaging intervention to identify potentially
dangerous and re- admission causing symptoms in patients with Short Bowel Syndrome (SBS) on
Total Parenteral Nutrition (TPN). Each consented patient will receive weekly text messages
inquiring about potentially harmful symptoms identified by a team of physicians. If the
patient screens positive via text message, an alert will be sent to the medical team. All
patients with SBS on TPN will receive text messages. The investigators will be monitoring
response rates to text messages screening for potentially harmful symptoms and compare the
text- message response rate to historical rates of successful calls by nurses.
All patients with SBS on TPN will receive text messages instead of weekly phone calls from a
nurse. If the patient does not respond to the text messages or the text message responses
suggest that the patient may be presenting with potentially harmful symptoms, the nurse will
call the patient to inquire about more information.
dangerous and re- admission causing symptoms in patients with Short Bowel Syndrome (SBS) on
Total Parenteral Nutrition (TPN). Each consented patient will receive weekly text messages
inquiring about potentially harmful symptoms identified by a team of physicians. If the
patient screens positive via text message, an alert will be sent to the medical team. All
patients with SBS on TPN will receive text messages. The investigators will be monitoring
response rates to text messages screening for potentially harmful symptoms and compare the
text- message response rate to historical rates of successful calls by nurses.
All patients with SBS on TPN will receive text messages instead of weekly phone calls from a
nurse. If the patient does not respond to the text messages or the text message responses
suggest that the patient may be presenting with potentially harmful symptoms, the nurse will
call the patient to inquire about more information.
Short Bowel Syndrome (SBS) is a condition that results from a host of different conditions,
the most common of which is Necrotizing Enterocolitis. Patients who have SBS are often Total
Parenteral Nutrition (TPN) dependent. TPN is a carefully formulated intravenous nutrition
that is utilized either alone or in conjunction with gastrointestinal feeds in patients who
fail to achieve adequate caloric intake enterally. According to the American Society of
Parenteral and Enteral Nutrition, 360,000 hospital visits required usage of TPN in 2009.
Short and long-term use of TPN is associated with catheter infections, cholestasis, liver
failure, refeeding-syndrome, hyperglycemia, bone demineralization, and death (1). Thus
careful and comprehensive monitoring of patients on TPN, especially after hospital discharge
is essential (1-3). Some hospitals have introduced resource intensive support teams
consisting of various health care professionals to manage these costly patients (1).
Using a variety of definitions, the incidence of SBS has been estimated at approximately 0.02
to 0.1 percent among all live births (4, 5), 0.5 to 2.0 percent among neonatal intensive care
unit (NICU) admissions (4, 5), and 0.7 percent among very low birthweight infants (6).
Approximately 80 percent of pediatric SBS cases develop during the neonatal period.
The average cost of care in the US for a single pediatric patient with SBS is $550,250 +/-
$248, 398 for the first year of care alone (7). These costs were attributable to prolonged
requirements for intensive care resources, numerous surgical procedures, multiple
readmissions, TPN and home care during the first year of diagnosis. Interestingly, Spencer et
al. suggested that hospital-based costs steadily declined in subsequent years, but home-care
services increased every year for the first 5 y of diagnosis (7). This increasing cost was
attributable to increasing complications of TPN, especially infectious complications
(something our application will specifically try to identify). The mean total cost of care
per child over a 5-y period was US$1,619,851 +/- US$1,028,985 (7).
At Cardinal Glenon, a significant amount of time (about 10 hours per week) is spent by nurses
calling these patients. This automated system will allow nurses to spend a portion of these
10 hours performing other activities, significantly reducing the costs attributed to SBS
patients. Also, most of the mothers of patients who have SBS are between the ages of 15-30.
This generation of millennials often have an aversion to phone calls and prefer texts [8].
Text- messages can be answered at a convenient time for the parent while the parent must be
present and available to answer a phone call. Multiple prior text message or application
intervention studies have reported high response rates, high satisfaction, and improvement in
outcomes (9-12). For example, Devitto et al. reported that the estimated odds of reporting
critical care symptoms of application group was 8.9 times that of control and showed slightly
higher adherence to the prescribed regimen (OR 1.64, 95% CI [1.01, 2.66]) (9). Martinez et
al. reported that 16 patients would have returned to the hospital without photos of surgical
sites prompting health care team intervention (12). Our automated texting system may improve
response rates from these young parents.
For this project, the investigators will be examining the effect of an Epharmix text
messaging intervention on identifying potentially dangerous and re-admission causing symptoms
with SBS patients on TPN.
the most common of which is Necrotizing Enterocolitis. Patients who have SBS are often Total
Parenteral Nutrition (TPN) dependent. TPN is a carefully formulated intravenous nutrition
that is utilized either alone or in conjunction with gastrointestinal feeds in patients who
fail to achieve adequate caloric intake enterally. According to the American Society of
Parenteral and Enteral Nutrition, 360,000 hospital visits required usage of TPN in 2009.
Short and long-term use of TPN is associated with catheter infections, cholestasis, liver
failure, refeeding-syndrome, hyperglycemia, bone demineralization, and death (1). Thus
careful and comprehensive monitoring of patients on TPN, especially after hospital discharge
is essential (1-3). Some hospitals have introduced resource intensive support teams
consisting of various health care professionals to manage these costly patients (1).
Using a variety of definitions, the incidence of SBS has been estimated at approximately 0.02
to 0.1 percent among all live births (4, 5), 0.5 to 2.0 percent among neonatal intensive care
unit (NICU) admissions (4, 5), and 0.7 percent among very low birthweight infants (6).
Approximately 80 percent of pediatric SBS cases develop during the neonatal period.
The average cost of care in the US for a single pediatric patient with SBS is $550,250 +/-
$248, 398 for the first year of care alone (7). These costs were attributable to prolonged
requirements for intensive care resources, numerous surgical procedures, multiple
readmissions, TPN and home care during the first year of diagnosis. Interestingly, Spencer et
al. suggested that hospital-based costs steadily declined in subsequent years, but home-care
services increased every year for the first 5 y of diagnosis (7). This increasing cost was
attributable to increasing complications of TPN, especially infectious complications
(something our application will specifically try to identify). The mean total cost of care
per child over a 5-y period was US$1,619,851 +/- US$1,028,985 (7).
At Cardinal Glenon, a significant amount of time (about 10 hours per week) is spent by nurses
calling these patients. This automated system will allow nurses to spend a portion of these
10 hours performing other activities, significantly reducing the costs attributed to SBS
patients. Also, most of the mothers of patients who have SBS are between the ages of 15-30.
This generation of millennials often have an aversion to phone calls and prefer texts [8].
Text- messages can be answered at a convenient time for the parent while the parent must be
present and available to answer a phone call. Multiple prior text message or application
intervention studies have reported high response rates, high satisfaction, and improvement in
outcomes (9-12). For example, Devitto et al. reported that the estimated odds of reporting
critical care symptoms of application group was 8.9 times that of control and showed slightly
higher adherence to the prescribed regimen (OR 1.64, 95% CI [1.01, 2.66]) (9). Martinez et
al. reported that 16 patients would have returned to the hospital without photos of surgical
sites prompting health care team intervention (12). Our automated texting system may improve
response rates from these young parents.
For this project, the investigators will be examining the effect of an Epharmix text
messaging intervention on identifying potentially dangerous and re-admission causing symptoms
with SBS patients on TPN.
Inclusion Criteria:
- Patients under the age of 18
- Patients with a diagnosis of short bowel syndrome and who are treated with total
parenteral nutrition
- Patients able to understand English or have a caregiver who understands English.
- Patients must have caregiver who has access to a phone (landline or cell phone)
Exclusion Criteria:
- Patients who do not have access to a phone (landline or cell phone), and patients who
are not mentally able to consent to the study.
- Patients who are not treated with total parenteral nutrition.
- Patients who do no have a short bowel syndrome diagnosis
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