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How Massachusetts General Hospital Reduced Spinal Surgery Readmissions

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At the 10th Annual Meeting of the Lumbar Spine Research Society in April 2017, Louis Jenis, MD, presented a paper titled, “The Effectiveness of Personalized Electronic Patient Engagement Messaging Following Lumbar Spinal Fusion: A Pilot Study.” This paper was subsequently published in the Journal of Neurosurgery, along with other papers from the conference.

The focus of Dr. Jenis’ paper was a pilot he and his team led at Massachusetts General Hospital, in which psychographic segmentation and automated patient engagement were used to help reduce hospital readmissions following lumbar spinal fusion surgery. The pilot was considered successful, demonstrating that consumer industry techniques could be applied to helping lumbar spine patients.

  • PatientBond was used to engage patients during both preoperative and postoperative periods to motivate healthy behaviors and reduce the risk of hospital readmission. (As Seen in The Journal of Neurosurgery)

Background

Dr. Jenis and his team sought to reduce hospital readmissions following discharge after lumbar spinal fusion surgery. He noted that much focus has been placed on preoperative patient preparation and education, but less attention has been given to motivating patients and directing their behaviors post-surgery to facilitate a successful recovery. Moreover, while population health management efforts routinely segment patients by demographics, health condition and insurance coverage, these methods provide details on “what the patient is doing” and not “why the patient is behaving in a certain manner.”


Each patient was communicated with
postoperatively on day 2, 4, 6, 10, 14 and 21.


Dr. Jenis referred to previous research that had identified five healthcare related psychographic segments, each unique in its own motivations and communications preferences. The goal of the study was to apply psychographic segmentation to patients undergoing lumbar spine surgery and utilize a series of electronic, customized, automated messages designed to better prepare patients for the surgery and recovery period in the 30 days following surgery. The platform for automating the communications (i.e., emails, text messages, interactive voicemail) monitored progress and proactively detected any recovery issues.

Pilot Design

Dr. Jenis’ team enrolled 69 consecutive patients undergoing posterior lumbar spinal fusion surgery. Leveraging digital patient engagement, patients received automated communications five and two days prior to surgery with preparatory education (videos, written information).  Patients also received communications seven more times over 21 days post-surgery with additional education and short surveys to gauge recovery. Responses to these communications were captured on a dashboard and patient-indicated recovery issues were sent to ancillary staff via email and text messaging for immediate follow-up.  

Patients received messaging customized to their individual psychographic segment classification to appeal to their motivations and enhance the likelihood of positive behaviors.  Patients answered a 12-question survey used to classify them by psychographic segment during a pre-operative appointment, administered by the nurse.

Results

The 30-day readmission rate during the pilot study was 1.45 percent. Overall response rate to text, email and voice messaging across nine waves of communication was 87.5 percent, underscoring the effectiveness of psychographic messaging.  

Dr. Jenis concluded: “The psychographic segmentation tool is useful for engagement of patients and classified them per attitudes and beliefs. The pilot program has provided insights for deployment of medical resources to support patients and activate positive health behavior.” PB_favicon.ico

Download Mass General Pilot Study on Reducing Readmissions



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