Spend enough time toggling mindlessly between Snapchat, Tinder, and Candy Crush, and it's easy to forget that modern smartphones are nothing short of a technological marvel. On a day when the best-selling app in Apple's App Store is Facetune, "the original selfie editor," it's nice to be reminded that smartphones can, in fact, do more than cater to our most distractible, narcissistic tendencies.
Researchers at Johns Hopkins University have shown that Corrie, a custom app designed for patients who have survived heart attacks, dramatically reduces those patients' chances of being re-admitted to the hospital with complications. The simple bit of technology has the potential to save lives, improve outcomes, and save hospitals hundreds of thousands of dollars.
For patients who have suffered a heart attack and been treated in a hospital, being discharged is only the first step in long road to recovery. Medication non-adherence and re-admission for complications are two major concerns in the post-treatment phase. According to the American Heart Association, just 88 percent of patients fill the prescriptions they're given, 76 percent begin taking them, and 44 percent continue to do so. In one recent analysis, the majority of patients didn't understand the medication regimen they were being prescribed, and two-thirds left the hospital without a follow-up appointment scheduled.
At the same time, according to the Centers for Medicare and Medicaid Services, one in five heart attack survivors are re-admitted to the hospital for complications within a month of being discharged. Medicare annually covers 51,000 such re-admissions, with a bill that exceeds $693 million in additional hospital costs.
William Yang, a resident at Johns Hopkins, and his colleagues saw an opportunity to replace the traditional, paper-based discharge process with an interactive, digital one.
"Every day in the hospital, we walk into patients' rooms and see them using their phones or watching TV," Yang tells Pacific Standard. "It's clear that a lot of patients are engaged with their phones, and there is a lot of waiting time in the hospital. Why not try to intervene during those days of waiting when patients and families are likely to be the most engaged in their health care, do so in a way that patients will find engaging, and that they can take home with them? And so, Corrie was born."
Yang was part of the multi-disciplinary team that designed and built Corrie—a group that included members from Hopkins' nursing, business, engineering, and medical schools. (The app is built on Apple's CareKit framework, which allows developers to design health-related products for iOS by integrating with a device's many sensors and native features.) Yang and his teammates designed Corrie to interact with patients throughout the day, in multiple ways. It reminds them, via pop-up notification, when it's time to take a medication, and allows patients to record having done so—valuable information to both family members and in-home caregivers. It tracks patients' vital signs, including heart rate, mood, steps, and, thanks to a Bluetooth-enabled cuff, their blood pressure. It serves up videos and articles about cardiac rehab, diet modification, exercise, and smoking cessation. And it allows patients to schedule and track follow-up appointments with the hospital.
"We hear from a lot of our patients that they often feel lost or overwhelmed both by what happened and everything that needs to happen afterwards. A heart attack often means new medicines, new doctors, lifestyle changes, and a lot of new information," Yang says. "At the same time, the way that we reach out to patients doesn't always meet patients where they are. Our patients often spend several days in the hospital after a heart attack recovering and being monitored for complications, yet a lot of the learning comes in paper form and on the day of discharge."
To test their app in a real-world setting, Yang and his colleagues recruited 60 recent heart attack survivors in Hopkins' hospital network. Thirty of the patients already had an iOS compatible device; the other 30 were given a loaner iPhone, free of charge, with Corrie pre-loaded on the device. (All patients were also given an Apple Watch to borrow during the study.) The patients were trained to use Corrie during their hospital stay, to ensure they knew how to navigate its full suite of features. After they were discharged from the hospital with the app, the researchers followed their progress for a month.
The results, which Yang presented last week to the American College of Cardiology, were striking. Across Hopkins' hospital network, the typical 30-day re-admission rate for heart attack survivors is 19 percent. Of the 60 patients in the Corrie cohort, however, just two returned to the hospital for complications within 30 days—a re-admission rate of three percent.
By producing better patient outcomes, the app doesn't just save lives; it also saves dollars.
Owing to a provision in the Affordable Care Act, Medicare has, since 2012, penalized hospitals—in the form of non-reimbursement—for patients re-admitted within 30 days. (The measure is designed to improve patient care, although a recent study in JAMA Cardiology suggests that it may be having the opposite effect, in some cases leading to higher patient mortality.) Yang and his colleagues estimate that, by reducing the number of heart attack patients who returned to the hospital, Corrie saved Hopkins $262,500 in re-admission penalties.
"We were surprised, and are very encouraged by our results so far," Yang says. "Our study is still actively recruiting patients, but it is important to mention that it is an observational study, which makes it harder for us to say that the entire difference is because of our intervention." The next step, then, is to conduct a randomized controlled trial, which Yang calls "the gold standard in medical research for studying effectiveness."
Given that 77 percent of Americans now own a smartphone, apps like Corrie stand to affect the health-care system in unprecedented ways, offering better outcomes for more patients at a lower cost. Beyond heart attack survivors, Yang and his colleagues imagine free, Corrie-like apps for patients with COPD, pneumonia, and diabetes—all of them easily scaled and translated into other languages.
"If you search for health apps on the app store, you'll find a lot of them. Smartwatches are also becoming more popular, including workout apps and heart rate monitoring features," Yang says. There hasn't been a lot of scientific research yet, though, to see what sort of difference mobile health technology can actually make on outcomes."