Smartphone App to Manage Cirrhotic Ascites: Continues to Improve as Program Enrolls Mores.

Patricia Pringle Bloom, M.D.
Fellow in MGH Transplant Hepatology 
PGY 7
09/13/2019

I am leading a team to improve the way we manage cirrhotic ascites. Body weight is an effective proxy for ascites volume; therefore, monitoring daily weights is recommended for optimal ascites management. At present, patients with ascites rarely proactively alert providers with significant weight gains, and there are no widely available technologies specifically designed for ascites monitoring. With support from COE funding, we are performing a pilot study to assess the feasibility of an app created by Partners Connected Health to manage outpatient ascites.

In this pilot study, we are identifying cirrhotic patients with significant ascites requiring specialist management. Each patient is sent home with a Bluetooth-connected scale, which transmits weight data to the PGHD Connect Smartphone app, and then via the cloud into Epic. Weights are monitored every weekday by study staff and alerts are sent to providers if their patients' weight changes by 5lb within a week or since discharge.

Acceptance to a local and exciting technology conference

Thus far, 21 patients have enrolled in the program. Eight patients have been unable to enroll because they did not have a Smartphone and 23 because they were encephalopathic and unable to participate. Each patient is enrolled for 28 days, but several patients have wanted to terminate the program early and several have opted to extend their enrollment.Thus far, the program has transmitted weight data on 70% of days that patients are enrolled. Technology issues are occurring on approximately 10% of days. Twenty weight alerts have been fired, ~60% for weight loss and the remainder for weight gain. 65% of the alerts have been followed with some form of provider response.

We continue to enroll patients in this program, and as we do, we we continue to work with Partners Connect Health to develop new iterations of the app that enhance the program. For example, new iterations of the app are being released that resolve some of the technology glitches. In addition, we are beginning to learn more about the types of patients who do best in this program. Part-way through our study, it appears that patients with less severe disease derive more benefit from the program. It also appears that those discharged to rehab facilities have more technical issues with the program.

Recently, our efforts have been rewarded with an invitation to present our interim results at the 2019 Connected Health Conference. This will be an excellent opportunity to gather feedback on our program and app, as well as network with others working in this space.