Launch of Connected Cognitive Health Platform

AFFIRMATIVhealth, PLLC presenters of RE:mind, a program created to improve brain health for the millions impacted by Alzheimer’s or dementia, has chosen AidCube as their mobile health platform.

Together, AFFIRMATIVhealth and AidCube are delivering a personalized protocol-based mobile tool for individual support and follow-up to RE:mind program participants, those affected by mild cognitive impairment and early stage Alzheimer’s disease.

The AFFIRMATIVhealth interventional program and protocol builds upon research done by The Buck Institute for Research on Aging . The protocol requires long-term modifications to the patient’s diet, physical condition and behavioral habits, which can be a challenge – especially in terms of remembering what to do on a daily basis.

AFFIRMATIVhealth is offering the RE:mind program in cooperation with Sonoma Valley Hospital and other providers.

The AidCube mobile health platform enables remote interaction with and among cognitive health specialists and RE:mind participants. The app integrates with the participants personalized protocol to include protocol compliance advice, videos, questionnaires, activity tracking and reminders focused on supplements, diet, exercise, sleep and stress management. The app also enables dialogue through secure messaging, text and video.

“We are very excited to introduce this innovative mobile tool, which enables constant engagement, and coaching opportunities following RE:mind’s immersion experience. It allows us to extend our precise, science-based protocol through this personalized app, continuously capturing feedback from our participants” says Denise Kalos, COO of AFFIRMATIVhealth.

Results of the mobile coaching program will become available in 2017. The main success criteria are patient program adherence and satisfaction with the mobile platform.

UCSF Telehealth Transplant Study

Background

Despite an overhaul in the system for donor lung allocation to reduce death rates on the waiting list, nearly 1 in 5 patients listed for lung transplantation dies before receiving a suitable donor offer. After transplant, there are trends towards increasing complications in the perioperative period; the immediate post-transplant hospital stay lasts more than a month for one in four patients and half are discharged to places other than home without in-home nursing support (e.g. skilled nursing facility).

The focus of this study is to perform an early phase home-based interventional trial to treat frailty in lung transplant candidates. The hypothesis is that a multimodal aerobic and strength training exercise program delivered through the Aidcube platform coupled with nutrition optimization will be feasible and improve Short Physical Performance Battery frailty scores, daily activity (by wearable monitor), and patient reported disability and health related quality of life.

Solution

UCSF chose to use the Aidcube platform, a fully customizable, commercially available digital “app”-based platform to deliver home-based pulmonary rehabilitation for patients with COPD based on ERS/ATS guidelines.

In partnership with UCSF, we customized the suite of exercises and features of our platform to meet the specific needs of the pilot study to treat frailty in lung transplant candidates in the United States.

On the patient-facing side, participants can view their daily exercise prescription, descriptions and videos demonstrating correct execution of the exercises, document completion of exercises, and message their health-care provider. On the provider-facing side, UCSF investigators can choose from over 150 available exercises, surveys, and activities to design a personalized and fully-customized exercise prescription. Based on real-time participant feedback, the exercise prescription can be progressed (i.e., advanced and/or modified) by adding repetitions or time to specific exercises or adding new activities. UCSF investigators can also message the patient from within the Aidcube environment. Weekly emails are automatically sent to the UCSF investigators summarizing each participants activity over the prior 7 days.

Results

Results will become available on this page, when the study is has been completed (during 2017).

Physical activity decreases risk of early death in COPD – How can mHealth help?

A recent study of 2.370 patients from Kaiser Permanente shows that any amount of moderate to vigorous physical activity can effectively reduce the risk of dying after hospitalization for chronic obstructive pulmonary disease (COPD).

In the US alone COPD cost $36 billion and claims about 135.000 lives every year. Hospitalizations due to severe exacerbations of COPD account for up to 70% of the healthcare costs associated with COPD.

The KP study found that patients who were active had a 47% lower risk of death in the 12 months following a COPD hospitalisation, compared to inactive patients. Patients who were active but at insufficient levels still maintained a 28% lower risk of death, compared to inactive patients.

Dr. Marilyn Moy, Assistant Professor at Harvard Medical School commented on these findings: “The results also demonstrate the importance of routinely assessing physical activity in clinical care to identify high-risk patients as part of a larger strategy to promote physical activity in this highly sedentary population.”

This is very interesting in relation to mHealth tools, that have shown an increased adherence to home exercise, by supporting the patient on the distance. One way to utilize this in everyday clinical practice is for supporting patients that have completed a 7-10 weeks Pulmonary Rehabilitation. It is well known that the benefit, on the long-term, of pulmonary rehabilitation is not significant. Therefore, the long-term value of pulmonary rehabilitation, could potentially be improved by empowering and engaging patients through mHealth.

Sources:

Physical activity found to decrease risk of early death in COPD

Maintenance after Pulmonary Rehabilitation in Chronic Lung Disease

International Mobile-Health Intervention on Physical Activity, Sitting, and Weight: The Stepathlon Cardiovascular Health Study

mhealth

Why mHealth sometimes fails

During the past couple of years, about a thousand COPD patients have used our mHealth tool at home. We have trained healthcare staff at 26 different hospitals and clinics. Therefore, we are now able to see patterns in why it sometimes takes a long time for a connected mHealth tool, like ours, to provide value. We also see cases where the expected benefits were realized much earlier than expected.

Let’s start with the things that go wrong.

No implementation is the same, but based on our experience, we see a few primary reasons for why connected mHealth/eHealth implementations are failing or take longer than expected. The first one is organizational readiness. Does the key staff, who will be a driving force in making the eHealth solution a success, have the time and skills needed to succeed? Most of the healthcare professionals we have worked with have been eager to make it work. However, some of them simply don’t have the time needed to train patients and do the follow-up, which are essential components to a successful implementation. These new processes take time to learn and master – and they are not always prioritized, because the everyday tasks are first in line. Therefore, it’s very important to make sure that the key people have enough time available during their work week – not only during the implementation phase – but especially when the mHealth tool is put into operation.

Another issue we have discovered is that providing too many options, that accommodate very specific and individual needs among patients and health care staff, cause more confusion than good. Starting off with a simple and easy plan is the way to go in many cases. Then, as usage and confidence increases, it makes sense to allow for detailed adjustments. The hard thing about this approach, is that you really want to show everything your system can do – and therefore tend to provide too many options during that initial phase.

You also need to accept that your eHealth service will not work for every single patient. However, our experience tells us that there is a strong correlation between healthcare staff engagement (primarily time available) and patient engagement. For implementations that have been running successfully for 1-2 years, we see that the time needed per patient is diminishing.

Sometimes, it’s important to admit that all the time in the world is not always enough. We learnt that a number of patients would drop off, no matter how hard you try. Therefore, it’s important to use a balanced amount of resources to get these patients back on track – because they can end up consuming a lot of time.

I have just touched a few key points in this post. I my next post I will go more into detail with some of the underlying reasons for why we either see mHealth projects fail or become a success.