RCT of automated hovering for congestive heart failure management

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 DESCRIPTION (provided by applicant): The goal of the proposed project is to conduct a pragmatic randomized controlled trial testing a new approach to chronic disease management combining wireless monitoring devices and behavioral economic engagement incentives to reduce rehospitalization rates among patients with Congestive Heart Failure (CHF) recently hospitalized at the University of Pennsylvania Health System (UPHS). We will enroll patients who have been admitted to a UPHS hospital with a principal diagnosis of CHF at least once in the past 12 months and randomize them to either: [1] Usual care with no additional intervention; [2] the provision of wireless medication adherence devices and scales with daily lottery incentives to encourage daily adherence. Specific Aims are: Aim 1: To leverage access to the UPHS CHF clinic, EPIC resources for identifying eligible patients, and the Way to Health platform to launch and enroll a practical clinical trial powered to detect differences in hospital readmission rates using remote monitoring devices for automated hovering for CHF management Aim 2: To evaluate the effectiveness of remote monitoring of medication and weight along with engagement incentives in reducing rehospitalization rates among high-risk CHF patients. Aim 3: To assess the cost-effectiveness of this intervention relative to usual care. We will utilize the NIH-funded Way to Health platform, constructed for testing behavioral economic interventions using wireless devices, as well as the Penn data store and electronic medical record (EPIC), which provide well developed tools for identifying appropriate patients and allow for bidirectional communication with the Way to Health platform to facilitate clinician awareness of patient progress. We will have minimal exclusion criteria to maximize generalizability. Our team will include the medical director of the CHF service for UPHS, and a team of experienced investigators including behavioral economists, internists, a cost effectiveness expert, and a statistician, with support for this initiative from the CEO of UPHS.