Perspectives of Inpatients With Cirrhosis and Caregivers on Using Health Information Technology: Cross-sectional Multicenter Study.

Chathur Acharya,Lori Bergstrom,Edith Gavis,Patrick S Kamath,Deborah B Mcguire,Andrew Fagan,Tejasav S Sehrawat,Amy Olofson,Sara Mcgeorge,Jasmohan Singh Bajaj,Jawaid Shaw,Melanie B White

doi:10.2196/24639

Abstract

BackgroundHealth information technology (IT) interventions to decrease readmissions for cirrhosis may be limited by patient-associated factors.ObjectiveThe aim of this study was to determine perspectives regarding adoption versus refusal of health IT interventions among patient-caregiver dyads.MethodsInpatients with cirrhosis and their caregivers were approached to participate in a randomized health IT intervention trial requiring daily contact with research teams via the Patient Buddy app. This app focuses on ascites, medications, and hepatic encephalopathy over 30 days. Regression analyses for characteristics associated with acceptance were performed. For those who declined, a semistructured interview was performed with themes focused on caregivers, protocol, transport/logistics, technology demands, and privacy.ResultsA total of 349 patient-caregiver dyads were approached (191 from Virginia Commonwealth University, 56 from Richmond Veterans Affairs Medical Center, and 102 from Mayo Clinic), 87 of which (25%) agreed to participate. On regression, dyads agreeing included a male patient (odds ratio [OR] 2.08, P=.01), gastrointestinal bleeding (OR 2.3, P=.006), or hepatic encephalopathy admission (OR 2.0, P=.01), whereas opioid use (OR 0.46, P=.03) and alcohol-related etiology (OR 0.54, P=.02) were associated with refusal. Race, study site, and other admission reasons did not contribute to refusing participation. Among the 262 dyads who declined randomization, caregiver reluctance (43%), perceived burden (31%), technology-related issues (14%), transportation/logistics (10%), and others (4%), but not privacy, were highlighted as major concerns.ConclusionsPatients with cirrhosis admitted with hepatic encephalopathy and gastrointestinal bleeding without opioid use or alcohol-related etiologies were more likely to participate in a health IT intervention focused on preventing readmissions. Caregiver and study burden but not privacy were major reasons to decline participation. Reducing perceived patient-caregiver burden and improving communication may improve participation.Trial RegistrationClinicalTrials.gov NCT03564626; https://www.clinicaltrials.gov/ct2/show/NCT03564626

Highlights

Patients with cirrhosis often require expensive inpatient and outpatient care, mainly centered around complications related to hepatic encephalopathy, variceal bleeding, ascites, and medication management [1]
The data are transmitted via a Health Insurance Portability and Accountability Act (HIPAA)-compliant server to central iPads, which the study team review for assessment of alarm values that are used for communication with patients and caregivers and to determine if action is required
Our results demonstrate that agreeing to participate in an intensive health information technology (IT) regimen aimed at preventing 30-day readmissions for inpatients with cirrhosis and their caregivers may depend in part on the cirrhosis etiology and reasons for inpatient admission

Summary

Introduction

Patients with cirrhosis often require expensive inpatient and outpatient care, mainly centered around complications related to hepatic encephalopathy, variceal bleeding, ascites, and medication management [1]. Methods: Inpatients with cirrhosis and their caregivers were approached to participate in a randomized health IT intervention trial requiring daily contact with research teams via the Patient Buddy app. This app focuses on ascites, medications, and hepatic encephalopathy over 30 days. Dyads agreeing included a male patient (odds ratio [OR] 2.08, P=.01), gastrointestinal bleeding (OR 2.3, P=.006), or hepatic encephalopathy admission (OR 2.0, P=.01), whereas opioid use (OR 0.46, P=.03) and alcohol-related etiology (OR 0.54, P=.02) were associated with refusal. Conclusions: Patients with cirrhosis admitted with hepatic encephalopathy and gastrointestinal bleeding without opioid use or alcohol-related etiologies were more likely to participate in a health IT intervention focused on preventing readmissions.

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