Innovation Center Kicks Off EMPOWER-H Pilot Study
Posted on Jul 19, 2012
In April 2012, the Palo Alto Medical Foundation’s (PAMF) David Druker Center for Health Systems Innovation officially launched the EMPOWER-H (Engaging and Motivating Patients Online With Enhanced Resources – Hypertension) pilot study, focused on developing a new program for helping patients with uncontrolled hypertension regain control of their blood pressure. Funded by a grant from the Gordon and Betty Moore Foundation, EMPOWER-H aims to improve the impact and outcomes of chronic care management by targeting home health behaviors and encouraging patients to use tracked data to take charge of their health and proactively change their own behavior.
In the 12 months prior to the kick-off of the pilot, the EMPOWER-H team undertook preparatory work in developing tools to drive sustained behavior change. Through alpha and beta phases of the study, team members tested processes and technologies and conducted ethnography to evaluate how patients handle hypertension in their day-to-day lives. Using knowledge acquired from both phases, the team was able to significantly improve its approach.
The refined program was then moved into the pilot phase, in which 151 patients were recruited and each equipped with a blood pressure monitor with cuff, a pedometer, a scale, an iPhone, and a Bluetooth device for transmitting blood pressure readings. All from the comfort of their homes, patients use an EMPOWER-H iPhone app to upload their blood pressure, daily number of steps, and weight to their interactive Personal Health Record. Their data is tracked by a designated nurse care manager who provides advice, often through MyHealthOnline. Nurse care managers and a dietician also partner with patients in formulating personalized Action Plans, with goals such as increasing the number of steps taken per day, changing their diet, or reducing the number of cigarettes smoked per week.
By giving patients the tools to measure and monitor their blood pressure, steps, and weight but more importantly, also showing them how they can interpret and use their data to improve their health management, EMPOWER-H seeks to cultivate more proactive, engaged patients. Because patients are receiving real-time feedback as well as continuing education and support from their care team without having to make frequent doctor’s visits, they are better equipped to more effectively self-manage their condition. A patient may observe trend data and see that, for example, a certain medication is helping to lower their blood pressure. This may give them confidence that their actions can positively impact their blood pressure and consequently motivate them to take other steps such as exercising more frequently or changing their diet.
Also developed as part of EMPOWER-H is an Epic-integrated population dashboard for exception-based care management. The system automatically triages patients into high, medium, or low risk categories based on their most recently transmitted blood pressure readings and their “behavioral activation risk,” a value based on whether patients have completed necessary steps in their Action Plans. The dashboard gives physicians and nurses a clear, organized look at their patients, allowing them to quickly spot and intervene with individuals at higher risk.
What sets EMPOWER-H apart from other studies of hypertensive patients? Numerous key features, but amongst the most important are ethnography and rapid cycle development. The EMPOWER-H team is using ethnography to understand not only a patient’s view of hypertension and the barriers that need to be overcome to achieve higher levels of engagement, but also how to modify the program to increase the ability of the care team to support behavior changes in patients. Rapid cycle development allows for learnings in one phase to be quickly processed, then implemented and tested in the next phase, giving the team the ability to make rapid and real-time beneficial advancements to the intervention.
The study is expected to wrap up in mid-December, but subject to the demonstration of positive results, the Innovation Center hopes to advance toward a new phase—deployment of the program on a limited scale in day-to-day care in the clinic. Together, experience in home monitoring and driving patient engagement and developing processes for managing larger populations of patients are all relevant to the wider objectives of the Innovation Center: health improvement, disease management, and successful aging.