Opportunity 

The Plastic and Reconstructive Surgery (PRS) team at Penn Medicine performs more free flap breast reconstructions than any institution in the United States. The world-class care they provide attracts patients from across the country and international locations.   

Due to the high volume of demand, more than 50 percent of new patients experience delays in scheduling their first appointment. Such delays can lead to decreased patient satisfaction, loss in revenue, and increased patient and provider anxiety.   

After undergoing autologous breast reconstruction, patients are discharged in a homebound state with up to six surgical drains, leaving them severely restricted in their mobility and unable to drive. Despite being homebound and eligible for home health benefits, patients and their caregivers have historically had to return to the office multiple times within the 90-day global period to receive routine postoperative care, including drain removals. Each roundtrip visit can take up to four to five hours for patients due to travel, parking, walking, waiting, and clinical time.   

Intervention 

Working in partnership with the PRS team, we set out to challenge the long-standing status quo that required patients to commute to and from the clinic for drain management and removal and routine follow-up care. Together, we created the Connected Approach to Recovery (CARe) program, which shifts care from a high-touch clinic-based model to a digitally enabled home-based strategy.   

CARe enables patients to receive drain removals in the home, conducted by Penn Medicine's home health team – negating the need for multiple in-office visits after surgery. Patients who meet criteria are enrolled in an automated remote monitoring program powered by Way to Health. The program leverages text messaging to support and facilitate home health scheduling needs, monitor patient status, and automatically validate surgical drain removal criteria in real-time. The program also replaces the traditional, two-month routine follow-up visit in the clinic with a text-based check-in.   

Impact 

CARe reduces the physical and logistical burdens on patients and caregivers, enhances patient and provider satisfaction, reduces the administrative burden on clinic staff, and ensures a more patient-centric return to independence.  

Following the program's introduction in 2019, PRS saw a 58 percent decrease in mean clinic visits per patient occurring within the first 30 days following discharge and a 60 percent reduction in mean estimated roundtrip commuted miles for patients.  

The automated remote monitoring system received a net promoter score (NPS) of 87, and PRS and home health received an NPS of 90 and 95, respectively, based on CARe patient ratings.   

By eliminating three to four in-office visits for post-surgical patients, CARe creates capacity within the PRS clinic, opening up appointment slots for new patients and enabling providers to practice at the top of their license.   

Within one year, the CARe program was expanded to additional surgical patient populations across multiple hospitals and home health agencies. And when the COVID-19 pandemic hit, it allowed patients to receive uninterrupted postoperative care safely in their homes.    

The team continues to focus on expansion with the hope of transforming additional value-based contexts for optimized care. Learn more about the iterative design approach we used to develop CARe in this NEJM Catalyst article.