Together Care
Project status
Collaborators
Nawar Latif, MD, MPH, MSCE
Leslie Andriani, MD
Innovation leads
Funding
Innovation Accelerator Program
Opportunity
Penn Medicine's gynecologic oncology division serves a medically and socially high-risk population conducting an average of 162 surgeries and 435 chemotherapy visits per month. From 2017 to 2019, gynecologic oncology patients accounted for more than 700 emergency department (ED) visits, with patients from high community need index zip codes representing 45 percent of visits. Between 8 to 11 percent of patients in this population experience an unplanned readmission or ED visit after surgery – resulting in approximately $4.5 million in costs per year.
Intervention
Together Care is a personalized pathway that integrates digital support and home care services for gynecologic oncology patients undergoing surgery or chemotherapy. Using the Way to Health platform, Together Care provides text message–based perioperative education, chemotherapy and postoperative symptom management recommendations, and streamlined patient triage support. Additionally, patients with highly complex surgeries or medical comorbidities are given early referrals to home health to better facilitate home-based, comprehensive care.
Impact
Initial Together Care pilots showed signs of promise in target areas. For example, in the pilot with surgery patients, no participants visited the ED or were readmitted, signaling positive clinical outcomes and avoiding an estimated $400,000 in direct costs. Likewise, none of the participants in a pilot with chemotherapy patients had a preventable ED visit or admission. Patients in both programs reported high satisfaction, and no care disparities based on race and zip code were identified.
This project is part of our 2021 Innovation Accelerator class. In phase two, the team tested an automated version of the texting program to provide continuous support for patients and to keep their care team connected to their well-being during recovery and chemotherapy.
In May 2023, the automated program scaled to full clinical practice, becoming standard of care within the Department of Obstetrics and Gynecology.
Way to Health Specs
Learn more about the platformInnovation Methods
Fake back end
Fake back end
Fake back end
It is essential to validate feasibility and understand user needs before investing in the design and development of a product or service.
A fake back end is a temporary, usually unsustainable, structure that presents as a real service to users but is not fully developed on the back end.
Fake back ends can help you answer the questions, "What happens if people use this?" and "Does this move the needle?"
As opposed to fake front ends, fake back ends can produce a real outcome for target users on a small scale. For example, suppose you pretend to be the automated back end of a two-way texting service during a pilot. In that case, the user will receive answers from the service, just ones generated by you instead of automation.
Fake back end
We first conducted text message-based patient evaluations with a fake back end. We took the telephone script typically used for evaluations, created an algorithm for text messaging based on that script, and had a care team member send and reply to text messages according to the algorithm. This allowed us to evaluate the texting program and refine the algorithm in response to patient and provider feedback before setting up the automated texting service.