Ochsner Health System in New Orleans was able to get a little over two-thirds of their out-of-range hypertension patients within range in 90 days by having those patients measure their blood pressure once a week with a connected device. Dr. Richard Milani, the chief clinical transformation officer at Ochsner, shared some results from the program at the MobiHealthNews 2016 event last week in San Francisco.
“Our delivery model, at least in our initial foray into hypertension, is instead of collecting one or two or three data points in the course of a year, we might collect the same number in a week,” Milani said.
The data goes to a dedicated group of non-physician hospital employees, who can provide health coaching and medication management assistance to the patients. They can also trigger text message and email reminders about taking readings and medications, and send encouraging messages when patients are doing well.
The data showed that average systolic blood pressure dropped from a little over 150 mmHg at baseline to around 140 after 30 days and 135 after 90 days. Diastolic went from 83 at baseline to 78 after 60 days and 77 after 90 days. The percent of patients with high sodium intake went from 54 percent to 41 percent in six months.
At the end of 30 days, 50 percent of patients in the digital intervention group were under control, compared to zero percent at baseline and 11 percent of usual care patients after that same time. By 60 days 57 percent of digital users and 13 percent of usual care users were under control, and at 90 days 62 percent of the digital group had their blood pressure under control, compared to just 15 percent of regular care patients.
Patient activation and patient satisfaction were very high, Milani said. Despite only requiring patients to take a reading once a week, Ochsner received 4.2 readings a week on average.
“When we look at satisfaction, people like the program,” he said. “They find it pleasurable and they think it’s much more meaningful for them than a usual care scenario, going to the doctor a few times a year. We’ve shown a statistical improvement in mean patient activation. We’ve also cut the percent of the population that has low activation down by about a third. So what we found is this: the mere act of participating in the program is an activator. Obviously we’re doing other things to try and drive activation but just merely taking BP readings at home [helps].”
The patients in this cohort had an average age of 67, Milani said, and Ochsner even controlled for self-reported “tech-savviness”. The results bucked the stereotype that older folks won't engage with connected mobile technology.
“So there are people who are not technologically savvy,” Milani said. “They get the same results, they send the same number of readings, they accomplish the same goals as the people who aren’t. And that’s actually important because you can see where a doctor might say ‘Mrs. Johnson is just a little too out of the technology stuff, she could never do this.’ And the answer is ‘Oh yes she can, and she does it just as well as everyone else.’”
Finally, Milani said, Ochsner intends to capitalize on the positive results by expanding the program right away.
“We have about 500 patients now, we want to be trying to hit 1,000 before the end of the year,” he said. “Next year we want to have several thousand within our own network. Obviously it’s scalable because you could put the whole bunker for lack of a better term, since this is virtual, anywhere you want. Everything is done online. So as long as there is a license to practice and change medication within the state, you could scale this infinitely. This was built for scale.”