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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.

27 comments

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Photo of Nita Lakhani
Team

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.

Photo of Kate Rushton
Team

Hi Erin and team

Thank you for all your hard work in this challenge and dedication.

All of the ideas posts are locked but the comments section is still open, so please feel free to look at other ideas and comment on them, seek feedback on your idea etc.

I know I have asked many ideators this question but I am asking again as some ideas pivoting in the challenge. Would you say your idea is Most Viable or Most Promising? How would the incentives associated with that Award (Most Viable/Most Promising) be helpful for you?

Photo of Tamara Deangelis
Team

I am excited to hear of the future plans after the challenge! As part of the team on the research project above, I experienced firsthand the impact this technology could have on seniors staying connected to a healthcare professional. I look forward to hearing more about Wellpepper reaching individuals in their local communities through senior centers and council on aging departments.

Photo of Erin Campbell
Team

Tamara Deangelis Thank you for your support and contributions!

Photo of KIN LING
Team

I really appreciate your idea which actually makes good use of technology in helping old adults, the biggest concern for me is that elderly are always not familiar with new technology, there is a risk that they are not willing to learn or cannot accept engaging in virtual healthcare consultation. How can the organization deal with that?

Photo of Erin Campbell
Team

KIN LING We haven't found this to be an issue. Many care providers do not believe that older adults can successfully adopt the use of iPad technology. The pre-Boston RISE Study focus groups of adult patients with mobility problems suggest otherwise and highlights that most older adults are offended by this assumption. A Wellpepper App user who had one knee replacement without using the Wellpepper App and her second knee replaced with the app said, "I would not want to have another knee surgery without the app. I was 81 and it wasn’t hard for me at all!"

Photo of KIN LING
Team

I can see your point, however, what about for the elderly who cannot afford a smartphone or who was not using a smartphone?

Photo of Erin Campbell
Team

KIN LING  This is certainly an issue. As we move forward into community settings, we will be looking to collaborate with physicians and community state holders to solve this problem.

Photo of Barry
Team

Hi Erin Campbell I really like this idea, we are working on a related idea, screening for falls risk then automatically prescribe a tailored intervention (including exercise). The patient would follow the exercise programme and monitor their progress at home using an app:
https://challenges.openideo.com/challenge/fall-prevention/refinement/reducing-the-incidence-of-falls-through-improved-assessment
The app would deliver video or animation content on the prescribed exercise which would be progressive, targeted strength and balance.

Barry

Photo of Kate Rushton
Team

Hi Erin,

We are half-way through the refinement phase and I can’t wait to see continued updates on your idea. More information can be found in the refinement toolkit which can be found at the top of the refinement phase page.

An easy first step is to complete the refinement questions which can be found by logging into your OpenIDEO account and selecting the ‘Edit Contribution’ button on the top left hand corner.

If you scroll down to the bottom, you can see the five added questions with a character limit (including spaces) to help you focus your answer. The questions start with "How would you describe this idea while in an elevator with someone? (what's the elevator pitch for this idea?) - 400 character limit"

In addition to answering these questions it would be helpful if you could mention how your solution fits in the market in the ‘full description’ section of your post. Who are your competitors and how is your idea unique?

If you have any questions, please feel free to reach out to me, my email address is krushton@ideo.com

Hope to see you on the refinement call this Friday at 9 am PST.

Photo of Bettina Fliegel
Team

Hi Erin. This customized approach is great as it seems to be motivating! It feels like a remote personal trainer. Are there telemedicine codes that might cover the remote follow up care done by the physical therapists?

Regarding your questions above I think it is great to facilitate initiatives locally to reach seniors. How are you doing outreach now? Maybe start a senior advocacy committee, composed of seniors, that can visit and share the message in senior centers in the community? Within community medicine maybe reach out to organizations such as http://www.chcanys.org - to share the app once available?

Photo of Erin Campbell
Team

@bettinafliegel No there are not current telemedicine codes. This is one of the reasons Brandeis is doing the evaluation of the costs of the program, so that we can justify having it paid for. This is another reason we need help to scale. Private practice PTs may not care as much about reimbursement for follow up---we’ve seen that before.
I think you’re right, we could definitely say that’s why we entered the contest. I think we might also think about a light-weight (non-PT driven) intervention that is about falls awareness---maybe just sending SMS tips to start, and then becomes “ask your PT for your personalized program”. At the very least, I think an in-person PT visit is covered.

Photo of Bettina Fliegel
Team

Hi Erin. Congrats on moving the idea into refinement!
I like your idea to create a text messaging platform for awareness. There might be learnings from text4baby, a free health messaging platform for pregnant women and new mothers. It was set up to reach underserved populations with critical health information, and is supported by broad public private partnerships. I wrote a research post about the app. https://challenges.openideo.com/challenge/fall-prevention/research/addressing-a-national-health-priority-using-mobile-technology-text4baby)
In general pediatric care there is emphasis on anticipatory guidance. Age appropriate safety tips are shared at routine health care visits. Using this app tips, linked to age of the baby, are shared via messaging, 2 -3x/ week.

I wonder if this approach might be effective for tips re: general falls prevention, or tips related to injury recovery overtime?

Photo of Kate Rushton
Team

Hi Erin,

Welcome to the refinement phase.

I am interested to know how your product compares to other products on the market and what the current user journey is for the product.

There are a few finalist ideas from previous OpenIDEO challenges that might interest you.

WiseGranny (a finalist idea from our healthy lives challenge) has clear user profiles and user journeys - https://challenges.openideo.com/challenge/healthy-lives/top-ideas/economias-colaborativas-de-la-abuela

This Not So Retired Life (a finalist idea from our financial longevity challenge) has a really interesting strategy for outreach by leveraging local radio and journalists and uses headings in a way that really helps structure the idea submission - https://challenges.openideo.com/challenge/financial-longevity/top-ideas/the-not-so-retired-life

Would you say your idea is in the category of most viable or most promising idea?

If you have any questions, please reach out to me on krushton@ideo.com or tag me here using ‘@‘ and Kate Rushton

I would recommend taking a look at the other ideas in the refinement phase, offering feedback and asking them to comment on your post with recommendations on how to scale your program. We have a wide range of people in the challenge with a lot of expertise across the healthcare space.

Photo of Rebecca
Team

After this product is scaled, would patients' doctors be able to monitor activity and recommend specific exercises? How is access to activity and monitoring/controlled/customized?

Photo of Erin Campbell
Team

Rebecca Yes, doctors and other clinicians can monitor patient activity and tailor the treatment plans based on outcomes and patient adherence to the treatment plan. The clinician invites the patient to a customized treatment plan and is then able to monitor as necessary. There is a built in notification system that alerts clinicians based on predefined parameters or requirements.

Photo of eldy wullur
Team

Hi Erin,
It's a convenient and sophisticated way to "force" the elderly to follow this program.
They will feel like being young again with gestures follow the instructor's through video, this is great fun.

Photo of Erin Campbell
Team

eldy wullur Thank you for your comment. Much of our feedback indicates that people enjoy the personalization offered by the app and are more inclined to follow through with their treatment plans because of it.

Photo of Lorna Brown
Team

As one of the physical therapist who delivered the technology/exercise intervention in this study, I'm excited about the possibility of expanding to a broader population. I feel that remote monitoring of exercise holds great promise in helping older adults adopt robust, sustainable exercise habits. This, in turn, can improve mobility, minimize fall risk, decrease healthcare spending and enhance the quality of life for older adults. Keep up the great work Wellpepper!

Photo of Kate Rushton
Team

Hi Erin!

Great to see Wellpepper published!


What is the current status of Wellpepper? How many users are on board?

Do you have a user experience journey for older adults using health platform that you can share with the OpenIDEO community?

I noticed the following sentence in your attachment and wanted to highlight it:

‘The program is consistent with Medicare funded services, but uses a number of innovations such as mobile health technology to demonstrate the potential for long term benefit.’

Photo of Erin Campbell
Team

@katerushton. We have 5500 patients currently using our app across 21 locations that range from private clinics and ASCS to hospitals and IDNs.

Below is a recent quote from an 81 year old patient who had one knee replacement surgery prior to using the Wellpepper app and a second knee replacement with the app. She lives by herself and is committed to remaining independent. “I would not want to have another knee surgery without the app. For me, it worked perfectly. It was user friendly. I was 81 and it wasn’t hard for me at all! With my first surgery, I wasn’t good at remembering exactly how to do the exercises. I don’t know why, but the app made it more personal. I could see myself doing the exercises and the pictures were clear. I also liked that it would ding and tell me when to do my exercises.”

Photo of Joanna Spoth
Team

Hi Erin! This is a really exciting initiative. I'm curious if you have thoughts on Kate's questions, below. Would love to learn more!

Photo of Kate Rushton
Team

Hi Erin!

There are 14 hours left to submit your idea to the challenge.

We noticed your post is currently unpublished. Was this your intention? We'd love to have it be included in the challenge. You can publish it by hitting the "Publish" button at the top of your post. You can also update your post by clicking on the "Edit Contribution" on top. We're looking forward to seeing your contribution in this challenge.

Photo of OpenIDEO
Team

Hi Erin!

Please tag @ and Kate Rushton if you want any assistance with this post.

Photo of Erin Campbell
Team

Kate Rushton  I had to change the title from the Research portion because the Idea section would not accept the same title. I would like to use the original Research section title. Yes, if you can move info via the backend, I would appreciate it. Can you move it in still leave it in draft form? The questions are slightly different in the Idea section so we'll need to do some editing before we publish.

Photo of Kate Rushton
Team

Hi Erin! I will get this done at the weekend.

Photo of Kate Rushton
Team

Hi Erin!

I have updated your post.