Leveraging Heath Information Technology to Improve Post-Discharge Management for Patients with Heart Failure

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Project Summary My long-term career goal is to become a clinician investigator, who uses health information technology (IT) to improve cardiovascular outcomes among patients with social needs. The research goal of this application is to use health IT to reduce preventable readmissions for heart failure (HF) among patients with low health literacy with the incorporation of behavioral science and usability testing. Social determinants of health (SDH) account for 80% of health outcomes, and social needs are associated with poor health outcomes, including 30-day readmissions. Addressing individuals’ social needs has been associated with improved clinical outcomes, but may take a prolonged time to effectively reduce 30-day readmissions. Health literacy, which measures a patient’s ability to find, understand, and use information and services to inform health-related decisions and actions for themselves and others, is associated with patients’ health outcomes. Low health literacy is common among patients with HF, and leads to poor management of HF. Extant interventions, such as patient navigators and handouts, have been utilized successfully to improve medical care for patients with low health literacy, but they are episodic and resource-intensive. The use of health IT tools, such as a personalized, automated text-message-based application, can be utilized for post-hospitalization care. Our preliminary study indicates that patients with HF who use this application had reduced 30-day readmissions, compared to patients with HF who did not use the application. However, the number of patients with HF using the application has been limited, due to low uptake and high attrition rate. The overall objective of the proposed research project is to incorporate nudges, and address barriers to improve patients’ use of the application, and conduct a pilot randomized controlled trial (RCT) to evaluate the application’s use in reducing 30-day readmissions. We will conduct qualitative work to gain insights into how to adapt an extant text messaging intervention to improve its use among patients with low health literacy (Aim 1), conduct usability testing and iterative revision of the application (Aim 2), and conduct a pilot RCT to evaluate the acceptability, feasibility, and preliminary efficacy of using behavioral interventions to increase the application use for patients with HF post-discharge (Aim 3). The training from this mentored career development award will provide skills in four domains: 1) behavioral science; 2) implementation science; 3) health literacy; and 4) RCT design and conduct. The proposed research activities, and the training and mentoring plans will provide the foundation for my career as an independent clinician investigator.