Case Study: CareSense

The Challenge

Surgery, and the amount of information given to patients to prepare for it, can be overwhelming. 

Yet, patient understanding and adherence to pre- and postoperative guidelines is critical for surgical success; noncompliance can lead to missed appointments, cancelled surgeries or readmissions. Within the Physician’s Organization at Houston Methodist, our surgical teams sought to improve patient education, preparation and adherence to postsurgical guidelines. The Center for Innovation partnered with CareSense to improve patient education via digital communication. 

The Solution

The Center for Innovation chose to implement CareSense, a mobile-first digital platform designed to guide patients through the surgical pathway using a variety of communication tools. The platform allows patients to choose their preferred method of communication — email, phone calls or SMS messages — to receive information about their surgery. The CareSense platform improves the patient experience because it provides information that is:

• Delivered according to the patient’s preference. Not all patients have the same learning or communication style. Empowering patients with choice gives them more control, and improves the likelihood they will receive and understand the information. 
• Received in a timely manner — when it is needed most. Rather than loading up patients with information at presurgical appointments, or at discharge, information is delivered at the most relevant time. From appointment reminders and alerts to videos and postsurgical checklists, patients receive helpful information when it is most relevant.
• Designed to answer frequently asked questions and escalate potential issues. Clear and consistent patient communication helps patients feel confident in their recovery and comply with their surgeon’s orders — without having to call the office and speak with a nurse. It also helps patients identify potential infections or other serious issues sooner.

The Pilot

Our team identified an ambulatory surgical location that had the necessary patient volume for a test pilot, in addition to a surgical and administrative staff that was eager to improve patient communications and willing to champion new technology.

Surgical procedures chosen for the pilot were:

• Heart failure
• Coronary artery bypass grafting (CABG)
• Aortic valve replacement (AVR) hip and knee replacement
• Lumbar fusion
• Colorectal, pancreatic Whipple surgery
• Transcatheter aortic valve replacement (TAVR)

For CareSense to be successful, it had to work with the existing clinical flow. Gathering the content to populate the tool required a lot of legwork. The Center for Innovation enlisted the help of service lines to ensure they had the elements that would most help the surgeons and staff. The team conducted interviews and focus groups to review and approve all of the content along each pathway. One of the benefits of creating digital pathways is the opportunity to update and standardize all information delivered over the course of the surgical timeline. 

Training the more than 60 clinicians and 20 surgeons was another important ingredient to success. The Center for Innovation knew that training had to be fast and effective, so we set up 15-minute phone and computer training sessions with multiple clinicians and office staff. The office staff offers CareSense to patients when their surgery is scheduled — and they receive their first communication two to three weeks before surgery. 

The initial pilot for CareSense launched Dec. 15, 2018. In the first three months, more than 260 patients participated. 

The Results

CareSense is a product that the physicians find value in and want to use — and that patients really appreciate. Patient feedback is measured as part of the program. And while we collect feedback from surgeons during debriefings, the majority of positive feedback has been unsolicited.

Patient Satisfaction

• 98% of participants “strongly agree” (on a 5-point scale) that the program was helpful. The remaining 2% of participants “agree” that the program was helpful.
• 75% have said they “strongly agree” when asked whether the system improved their knowledge and understanding on a Likert 5-point scale. The remaining 25% have said they “strongly agree” when asked whether the system improved their knowledge and understanding on a Likert 5-point scale.
• 84% patient adherence. An overwhelming majority of patients interact with the system, respond to the monitoring questions and read the content.

Physician Satisfaction

“My patient … said he was so ready and confident to have his surgery and that [Houston] Methodist had contacted him with so much information he was so ready. He said, ‘I loved it!’” 

“Finally, all my patients will be getting the same education.” 

“Now I know my patients are in trouble before they even know they are in trouble, which means we can stop potential problems before they become real problems.” 

What's Next?

As with all Center for Innovation programs, our goal is to quickly implement a pilot, build upon its success and address any issues. Our next steps will be to maximize adherence by sending follow-up reminders, converting some emails to text and looking for other ways to improve patient engagement. 

We will continue to roll out CareSense pathways to an expanded number of service lines and locations. 

The largest opportunity to evolve is to integrate CareSense and Epic. A continuum between the patient record and communication will offer greater opportunities to provide a more seamless patient experience, find efficiencies in operations, eliminate redundancies and, ultimately, improve outcomes.