A Web-Based, Provider-Driven Mobile App to Enhance Patient Care Coordination Between Dialysis Facilities and Hospitals: Development and Pilot Implementation Study (Preprint)

Abstract

We piloted a web-based, provider-driven mobile app (<i>DialysisConnect</i>) to fill the communication and care coordination gap between hospitals and dialysis facilities.

This study aimed to describe the development and pilot implementation of <i>DialysisConnect</i>.

<i>DialysisConnect</i> was developed iteratively with focus group and user testing feedback and was made available to 120 potential users at 1 hospital (hospitalists, advanced practice providers [APPs], and care coordinators) and 4 affiliated dialysis facilities (nephrologists, APPs, nurses and nurse managers, social workers, and administrative personnel) before the start of the pilot (November 1, 2020, to May 31, 2021). Midpilot and end-of-pilot web-based surveys of potential users were also conducted. Descriptive statistics were used to describe system use patterns, ratings of multiple satisfaction items (1=not at all; 3=to a great extent), and provider-selected motivators of and barriers to using <i>DialysisConnect</i>.

The pilot version of <i>DialysisConnect</i> included clinical information that was automatically uploaded from dialysis facilities, forms for entering critical admission and discharge information, and a direct communication channel. Although physicians comprised most of the potential users of <i>DialysisConnect</i>, APPs and dialysis nurses were the most active users. Activities were unevenly distributed; for example, 1 hospital-based APP recorded most of the admissions (280/309, 90.6%) among patients treated at the pilot dialysis facilities. End-of-pilot ratings of <i>DialysisConnect</i> were generally higher for users versus nonusers (eg, “I can see the potential value of <i>DialysisConnect</i> for my work with dialysis patients”: mean 2.8, SD 0.4, vs mean 2.3, SD 0.6; <i>P</i>=.02). Providers most commonly selected reduced time and energy spent gathering information as a motivator (11/26, 42%) and a lack of time to use the system as a barrier (8/26, 31%) at the end of the pilot.

This pilot study found that APPs and nurses were most likely to engage with the system. Survey participants generally viewed the system favorably while identifying substantial barriers to its use. These results inform how best to motivate providers to use this system and similar systems and inform future pragmatic research in care coordination among this and other populations.