R2 – Evaluation of promising mRehab tools, strategies and models of care

 
 

Project team

Project PI – Mike Jones

Frank DeRuyter, David Reinkensmeyer, John Morris, Amanda Rabinowitz, George Collier, Dalise Robinson, Meg Canale, Delaney Cowart

Project consumer/advisory team

Consumer Advisory Network

Provider Advisory Network

Purpose/aims

Project R2 will encompass three types of evaluation studies: 1) usability studies conducted as part of the iterative design process used in development of new tools and strategies and to confirm proof of concept and product; 2) efficacy studies to demonstrate acceptance and preliminary effectiveness of new tools and strategies; and 3) hybrid effectiveness-implementation studies to demonstrate effectiveness and identify challenges to implementation in a clinical setting. We plan to evaluate usability and efficacy of all interventions created in our development projects. We also plan to conduct at least one effectiveness-implementation trial to evaluate an alternative model of care utilizing mRehab therapy management tools to optimize delivery of outpatient therapy. Although funding is limited, we hope this preliminary trial will provide evidence to justify a larger trial, scaling up the model of care across multiple sites.

Status – Delayed

R2 initiatives are tied directly to the 3 main development projects in the mRehab RERC.

Evaluating usability and efficacy of the SEAM 2.0 platform.

The SEAM 2.0 platform incorporates many Identified “interventions” to address both administrative and “usability” problems associated with therapy management platforms.

 These include:

  • Setting up rules for auto-discharging patients from therapy to eliminate “ghost” patients in the system,

  • Adding a “reviewed-by” feature to document when and what exercises are reviewed with the patient by each therapist,

  • Encouraging/mandating a limit to the volume of exercises assigned to patients,

  • Incorporating the Flint Rehab Fit-Mi clips and pucks into repetitive motor exercises to facilitate easier documentation of adherence,

  • Providing therapists with iPads to help with prescribing exercises and reviewing progress with patients, and

  • Building Pt Pal information “dashboards” for therapists and therapy managers to provide easy access to performance information on key metrics (number of exercises assigned, frequency of review with patients, overall adherence)

Key accomplishments

One major implementation study on the SEAM platform has been completed at UC Irvine Medical Center. A manuscript on results has been accepted for publication. 

Swanson, V., Chan, V., Cruz-Coble, B., Alcantara, C., Scott, D., Jones, M., Zondervan, D., Khan, N., Ichimura, I., Reinkensmeyer, D. A pilot study of a sensor enhanced activity management system for promoting home rehabilitation exercise during the COVID-19 pandemic: User experience, reimbursement, and recommendations for implementation. International Journal of Environmental Research and Public Health. 2021.  

An implementation trial of the SEAM 2.0 platform is currently underway and will be a major focus of presentation and discussion at the Advisory Board meeting.  We have initiated a “stepped-wedge” implementation of the new SEAM platform across three groups, or waves, of therapists staggered by at least one month, or longer, based on uptake in prescription of sensor—enhanced exercises. This approach allows us to evaluate uptake and impact of the SEAM 2.0 enhancements by, for example, examining frequency of exercise review by therapists and level of exercise adherence by patients before and after implementation of the new platform.  Once the SEAM 2.0 enhancements are fully implemented across all teams, we will introduce the clinical manager and clinician dashboards to provide up-to-the-minute information about exercise prescription practices, frequency of review, and exercise adherence.

Challenges and course corrections

  • The SEAM 2.0 trial provides a real-world example of identifying challenges with implementation of a therapy management platform and enhancements to improve adherence.  However, the trial is being conducted in only one setting; replication in one or more additional settings is necessary but likely beyond the scope and available time in the current funding cycle of the RERC.

  • We hoped to evaluate the impact of the recently-implemented Remote Therapy Management billing codes under Medicare.  However, were not successful in getting these codes into the Shepherd Center “billing master” for this study.