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Scaling a proven falls prevention program with engaging mobile technology designed with empathy for seniors

We increase access to a proven BU and Harvard falls prevention program using a community delivery approach elevated by mobile technology.

Photo of Erin Campbell
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Who is your idea designed for and how does it enable older adults to live their best possible life by preventing falls?

"For older adults, a decline in mobility indicates a higher risk for disability, increased healthcare utilization and lower quality of life. Spaulding's Live Long Walk Strong program can decrease this risk, and by adding a digital component with Wellpepper we believe we can cost-effectively supply even better extended care.” Dr. Jonathan Bean, MD.

Falls and mobility limitations are largely preventable and there are opportunities for improving outcomes and access to quality focused care in both healthy and chronically ill older adults Mobility limitations are expected to add an additional $42 billion to healthcare costs by 2040 if new mobility specific care paradigms are not established. Currently, there is no drug therapy for mobility limitations and the most efficacious treatment is rehabilitative care. Principal investigators Jonathan Bean, MD and Terry Ellis PhD determined four attributes, limb strength, limb speed, range of motion and trunk muscle endurance, as predictive of decline in both basic and advanced mobility skills among older adults through the in-person intervention study, Boston RISE. In collaboration with patient engagement platform, Wellpepper, Inc. they have devised a methodology for delivering these interventions remotely via a digital intervention which is designed to improve patient mobility skills as well as muscle strength, endurance and power and to decrease the risk for fall-related injuries such as hip fracture. Using mobile devices running Wellpepper's patient engagement solution, the seniors can receive personalized video care instructions and easy-to-follow, customized strengthening and exercise prescriptions, and they will engage in regular communications with their healthcare providers through the Wellpepper application. Programs can be adjusted remotely as participants gain strength and mastery, without the need for internal visits. This enables greater access to care as one physical therapist can manage multiple patients and decreases barriers that seniors often have in traveling long distances to appointments. This methodology has been proven to work in a prior study conducted by Dr. Ellis for remote care of Parkinson’s patients. “Mobile Health Technology to Promote Physical Activity in Persons With Parkinson Disease” (Study is complete).

However, it does not address the cost issue, as this type of remote care is not currently reimbursed, which could limit adoption. Co-collaborator on the project Jennifer Perloff, PhD, Heller School for Social Policy and Management, Brandeis University is evaluating the costs of delivering care in this method and the ability to prevent falls vs. the costs of falls and decreased quality of life for seniors.

We are very excited about this new study, currently in progress, and have entered this challenge to further scale the outcomes through the OpenIDEO challenge. First, we would like to increase the impact and distribution by making this exercise protocol free of charge for users in any healthcare organization or plan looking to prevent falls in their senior population by providing the best care regardless of location and transportation access. Scaling this intervention would enable the research team to further refine the intervention based on feedback from thousands of patients and hundreds of physical therapists. It would also provide valuable insight to even further improve the technical experience for seniors. Second, the OpenIDEO challenge would enable us to raise awareness of the impact of this intervention with both CMS and private payers so that they are able to develop new models to support this proven cost-saving and outcome-driven initiative.

Working together with all stakeholders: providers, payers, researchers, and seniors and families we believe we can significantly decrease fall risk and improve quality of life.

User Journey

  1. Patient visits clinic to meet with Physical Therapist (PT)
  2. PT develops exercise program for the patient
  3. PT records a video of patient doing exercises while PT gives detailed instructions
  4. Patient leaves clinic with exercise program in an app on their phone
  5. Patient watches video and does exercises at home
  6. Patient interacts with PT via messaging within the app

Exercise programs can also be adapted for those with a caregiver. The patient and caregiver visit the clinic and a video is recorded of the caregiver assisting the patient with exercises while the PT narrates instructions. Both are taught how to use the app to follow the program at home. The patient and caregiver can communicate with the PT via messaging within the app.

PROTOTYPE

We have demonstrated our plan to  clinics and primary care physicians who have expressed interest in our train the trainer combined with mobile technology approach to falls prevention. We plan to partner with a community clinic to implement our falls prevention program. We will hold regular feedback meetings with both clinicians and users to modify this new delivery of care model. Because our app is already being used by physical therapists in a number of clinic settings, we already have a continuous quality improvement plan in place.

User Feedback

“I had my first knee replacement in the summer of 2015 and my second in the winter of 2016. I wasn’t good at remembering exactly how to do the exercises the first time. It was so much simpler using the app. It was more personal, I don’t know why. It would ding me and tell me when to do the exercises again. I thought it was easy to use. I would not want to have another knee surgery without the app. For me, it worked perfectly. It was user friendly. I am 81 years old and it wasn’t hard for me at all!” Evergreen Health Patient

“This program has empowered me, lifted my morale, renewed my hope, and given me tools. Thank you for helping me regain my life!”  Patient with Parkinson’s Disease, Boston University Center for Neurorehabilitation

What early, lightweight experiment might you try out in your own community to find out if the idea will meet your expectations?

We need to figure out how to scale this broadly into the community including getting payers on board for reimbursement. One of the reasons this idea works is that there is a remote person monitoring the patient's adherence. We'd like to introduce the program to senior centers to make it more broadly available and have the fitness professionals on staff monitor seniors remotely.

What skills, input, or guidance from the OpenIDEO community would be most helpful in building out or refining your idea?

We would like input from the OpenIDEO community regarding facilitating a culture of falls prevention within local communities especially in senior centers. We are also looking for guidance in increasing awareness and distribution in community centers.

How long has your idea existed?

  • Over 1 year

This idea emerged from

  • An Individual

Tell us about your work experience:

We are a broad, multi-disciplinary team coming from healthcare and technology backgrounds. Our clinicians have both research and clinical expertise and our technology team has moved from multi-national corporations into the start-up world. Team profiles can be found in "Our Team" attachment.

How would you describe this idea while in an elevator with someone?

Falls can be prevented with exercise programs. The Live Long Walk Strong program is proven to prevent falls. Our digital app scales this regional program and makes it available to seniors regardless of location. Seniors are the fastest growing group of mobile technology users. Delivering care through these tools will allow them unprecedented opportunities to remain independent.

How does your idea demonstrate our Criteria of Affordability?

When compared to the overall costs of a hip fracture, this program is extremely affordable. Brandeis University School of Public Health is doing this analysis as part of the REACH program, and we will leverage those results. Physical Therapy (PT) reimbursement is already covered in post-acute bundles and we need to expand this to preventative care. Additional programs for interstate licensure compacts and telemedicine reimbursement for PT will further help with affordability.

How does your idea demonstrate or plan to demonstrate scalability?

Mobile technology scales the regional intervention. Our mobile Falls Prevention Plan enables us to diversify the care team. One provider can support a large number of remote community or senior center exercise instructors who, in turn, can engage with and support a large number of seniors. Care givers and family members would be included in the care team by having easy access to their senior’s personalized exercise program thus ensuring adherence to the program and maximizing independence.

How do you plan to measure the impact of your idea?

The program is consistent with Medicare funded services, but uses mobile health technology to increase the potential for long term benefit. Adoption of such programs can change how mobility care is provided and thus broadly impact national healthcare reform initiatives. We will measure patient engagement, patient satisfaction, and falls with participants. Health systems will measure adverse events, like ED visits and hospital admissions in the population.

What are your immediate next steps after the challenge?

During this challenge, we have attracted interest from other facilities. We will plan a roll out of the digital app to these other facilities using a train the trainer approach. We will then sign up local community or senior centers and begin a pilot program to measure senior exercise adherence, satisfaction, safety in the home and health care utilization.

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Photo of Nita Lakhani
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Hi Erin & team!

This is a great idea that appears well-researched, with an interesting and engaging user video! My mother could have benefited from this after her fall. She had a few appts. with a physio, but doesn't continue to do her balance exercises regularly. She has an iPad, which if there was an app such as this, may have motivated her to continue her exercise program. My mom is in her early 70s and not quite technology averse, but does need guidance and encouragement to use technology. Her older sister is less tech savvy and would probably have difficulty engaging with an app. The cost of a tablet or smart phone would also be prohibitive to some seniors.

Have you received user feedback from seniors that are less comfortable with technology than the testimonial you provided?

Would Medicare or private insurance reimburse for the some of the cost of such technology if it is prescribed? In Ontario, there is limited funding for medical devices and these may include a tablet if it's essential for communication in disorders such as autism, but I'm unaware of funding for seniors at risk of falls.

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