Abstract 13541: A Digital Health Ecosystem for Coronary Artery Bypass Graft and Percutaneous Coronary Angiography Facilitates Recovery for Patients in Their Homes

Abstract

Introduction: The transition from hospital to home disrupts the continuum of patient care, adversely impacting readmissions and patient engagement. Our study objective is to develop and assess a Digital Health Ecosystem (DHE) intervention to mitigate CABG and PTCA readmissions and improve patient satisfaction with minimal clinician burden. Methods We developed and assessed a DHE combining evidence-based personalized content; web-based clinician dashboards; patient caregiver mobile apps; and nurse care plans and escalation protocols (figure). A tertiary-care hospital in Bangalore, India deployed the DHE to address post-discharge challenges of CABG and PTCA. India is attractive for testing digital health due to its large population, large mobile phone penetration, large out of pocket healthcare costs and positive telehealth attitudes. In an IRB-approved retrospective study, Jan-Dec 2019, we assessed patient outcomes and satisfaction for 799 patients (CABG=325; PTCA=474). We used an all-comers real-world approach without exclusions to assess feasibility. Results Escalations of care (n=7665), were greater in CABG (n=4772; 15 per patient) compared with PTCA (n=2893; 6 per patient). The figure shows 101 higher level escalations from 82 patients (48 CABG, 34 PTCA) with 41 resolved via virtual care and 60 resulting in 35 ED visits and 17 hospitalizations. Net Promoter Score (NPS) indicated patients were loyal and likely to recommend the DHE. The hospital NPS increased by 60%, from hospital reported baseline of 47 to 75. Conclusions Only 10.3% of patients after discharge had serious complaints. There were relatively few ED visits (4.4% of patients) and even fewer readmissions (1.9%). This contrasts with Indian studies showing 10-20% readmission after CABG. We demonstrated a DHE that provides improved post-discharge patient care and satisfaction and can be implemented alongside traditional healthcare. Moreover, this DHE may significantly reduce readmissions.