Weight is more than a Number: Performing an Outpatient Weight Monitoring Pilot Study.

Patricia Pringle Bloom MD

Fellow in Gastroenterology at MGH

PGY 6

March 20, 2019

Ascites refers to fluid build-up in the abdomen, and is a common complication of liver cirrhosis. Ascites accumulation leads to both patient discomfort and frequent health care utilization. At MGH, 30% of cirrhotic patients admitted to the hospital for a complication of cirrhosis are re-admitted within 90-days. Nearly 30% of those admissions and readmissions are for ascites management. Major American and European expert groups recommend that ascites treatments be adjusted based on body weight changes, as a surrogate of ascites volume. However, in our current practice, outpatient weight data often does not reach the hepatology provider.

Our team performed an interview study of cirrhotic patients readmitted to the hospital with a cirrhosis complication. We discovered that even in this ill and sometimes under-served group, approximately 80% of patients had a Smartphone and were interested in using an application to help manage their liver disease. We also interviewed several MGH hepatology providers to better understand the root causes of ascites readmissions and to learn about their desired features for an outpatient ascites management program.

Two team members hard at work, bringing a scale to another patient!

 Equipped with an understanding of what our patients need and what our hepatology providers want, we built a team at the MGH Liver Center to pilot an existing Partners application, called PGHD Connect, which allows weight data to be transmitted from home scales directly into EPIC. Our team is assessing whether patients weigh themselves regularly at home, and if hepatology providers respond to the weight alerts generated.

The most significant obstacle thus far was obtaining IRB approval, specifically with regards to the safety of patient data as it is transmitted through the PGHD Connect application into EPIC. Even though the application is already available for clinical use, the process to obtain regulatory approval was more detailed and time-intensive than we anticipated.

Another obstacle is the overall severity of medical illness in the patient population we are treating. Rarely does a patient with cirrhosis have ascites alone – they are also often burdened by other cirrhosis complications, co-morbidities, or socioeconomic challenges. Working around those other issues has been a challenge at times to ongoing patient participation.

At present, we have enrolled 3 of our planned 20 patients for the pilot. One patient and his provider have found the monitoring system particularly useful when he lost a large amount of weight after hospital discharge. Our next steps are to focus on patient recruitment and find an application developer to help us design an application even more specific to our target population and problem.

The major lessons I have learned from engaging in this research have been two-fold: 1) When working in a large team, creating a plan for regular communication about study tasks is imperative. Just as important, perhaps, is iteratively changing that plan as needed and making sure the entire team is aware and on board with changes. 2) Every human research study must tackle the important task of maintaining the privacy of patient data. Using digital health tools adds another layer to this task and must be managed thoughtfully and proactively. When in doubt, ask someone who knows more!