Diabetes is a serious public health epidemic across the nation but is even more prevalent in Kentucky, with the seventh-highest rate of the disease in the nation. In 2018, the Kentucky Department of Health reported that 13.7% of the population in Kentucky was diagnosed with diabetes and an additional 11.8% had prediabetes.

THE PROBLEM

Diabetes is one of the most costly chronic conditions with an estimated annual expense of $5.16 billion in Kentucky, driven by complications that include heart disease, stroke, blindness, nerve and blood vessel damage, kidney failure, and lower-limb amputation.

Strengthening efforts to prevent new cases and improving self-management for those diagnosed are part of a statewide approach to addressing diabetes. Under evidence-based guidelines for treatment and lifestyle management, diabetes can be controlled and sometimes avoided altogether.

One out of every four patients admitted to The Medical Center at Bowling Green has diabetes, and educating patients about the condition is essential to improving outcomes.

PROPOSAL

The Medical Center at Bowling Green is a 337-bed acute care facility and the flagship hospital for Med Center Health, a health system that serves a 12-county region in south central Kentucky.

The medical center identified video education as a means for establishing a standardized approach to patient education on diabetes. Helpful for hospitalized adults, videos primarily serve to supplement clinician-led teaching, and can enhance the retention of information over verbal instruction or print media alone, said Andrea Sturm, RN, a patient educator at The Medical Center at Bowling Green.

"The Medical Center at Bowling Green saw an upward trend in HCAHPS scores for medication communication and understanding care at time of discharge."

Andrea Sturm, RN, the Medical Center at Bowling Green

“Video education improves retention of information in patients with low health literacy,” she said. “To facilitate delivery of video education, the medical center implemented TeleHealth Services’ SmarTigr interactive patient engagement TV system in January 2017. The hospital added a robust library of videos to the system.”

Clinicians participated in go-live training to learn how to assign patient-specific education and launch videos on-demand through the computer-based StaffConnect application. Staff immediately appreciated the ease of managing the system from their workstations, as well as the benefit of the automatic charting of patients’ video views to the EHR through an added interface, Sturm said. Patients and their families can play videos on their in-room televisions.

MARKETPLACE

There are various patient education technology and services vendors on the market today. Some of these vendors include Emmi, HealthClips, Phreesia, Practis, PulsePoint, Sequence Health, Sonifi Health, ViewMedica and X-Plain.

MEETING THE CHALLENGE

At The Medical Center at Bowling Green, medication, demonstration of how to use, nutrition and condition-specific curricula were created to allow clinicians to easily assign and start videos for patients. Video views automatically record to the hospital’s Meditech EHR through an added interface to the SmarTigr system.

“To facilitate patient access and use of the system, the television instruction channel offers audio and printed instructions for video viewing,” Sturm explained. “Also a ‘video prescription’ card was implemented with simple instructions for locating patients’ assigned videos and launching them on their in-room televisions. A staff member provides instruction on system use and plays the hospital welcome video for the patient and or family members.”

Since improving medication communication was another focus for the medical center, clinicians recognized the need for expanding the medication videos with the addition of VUCA Health’s Meds on Cue video library to the SmarTigr system. Vendors for the system include Krames Staywell, Healthy Roads Media, Morrison Management Specialists, the CDC and the American Heart Association, and there are videos created in-house as well.

“In addition to using SmarTigr for video on-demand, we also reached patients through the system’s passive education and messaging features,” Sturm noted. “A creative series of disease-specific education campaigns with call-to-action messages were developed for broadcast over the SmarTigr system. For example, presentations on patient televisions featured a series of short videos about diabetes above a text message that reads, ‘If you don’t have a glucose monitor, we can help.’“

An extension is listed for patients to call. Patients see the messages while watching television and are invited to call for help to use glucose monitors. The patient educator brings a glucometer to the bedside and instructs the patient on use, maintenance and how to obtain supplies.

“The video system is used to facilitate rest and relaxation for patients during their stay to promote healing and decrease anxiety by using guided imagery from the C.A.R.E. Channel and TeleHealth Services,” Sturm added. “Selected channels display black screens with sounds such as ocean waves or oscillating fans to dampen hallway noise that may occur during a patient’s stay.”

RESULTS

Since the implementation of the SmarTigr system, video-on-demand utilization has steadily increased over time, currently averaging 1,000 views each month. Combined video views on diabetes topics and medications now comprise one-third of total patient-education viewing activity.

“Over the corresponding measurement periods for 2017 and 2018, the Medical Center at Bowling Green saw an upward trend in HCAHPS scores for medication communication and understanding care at time of discharge,” Sturm said.

“The Medical Center at Bowling Green’s successful adoption of the technology and the significant increases in utilization suggest that their use of the system for education and messaging helped to drive the improvements observed in corresponding measurement periods.”

The percentage of patients who reported that staff always explained about medicines before giving them improved by 6.9%. The percentage of patients who reported they strongly agreed that they understood their care when they left the hospital increased 16.3%. Kidney and diabetic complications decreased by 15% from 2017 to 2018. All-cause readmission rates decreased by 3% in the same time frame.

“Two promising new initiatives have recently launched, one of which seeks to address prevention of diabetes for patients at risk,” Sturm noted.

“We run a daily report of the patient census to locate patients with A1C values between 5.7% and 6.4% and assign a prediabetes video. The hospital’s second new initiative focuses on promoting a quiet environment and improving sleep. Nature programming and ambient sound content play throughout the night to mask noise and promote sleep.”

Too little sleep is associated with higher A1C levels and increased insulin resistance. The relaxation content also is being used in every unit throughout the hospital.

ADVICE FOR OTHERS

“Patients in a hospital are naturally filled with anxiety, fear and sometimes loneliness,” Sturm said. “Often, being hospitalized is a life-changing event. A hospitalization may pose challenges when trying to educate a patient about their health. They are sick and not in their preferred learning environment. The patient may not have the assistance of family members or a caregiver. To recognize ‘teaching moments’ offers up an opportunity for learning and retaining small amounts of information that are vital for activities of daily living from admission until discharge.”

Patients spend more time looking at their in-room televisions than anything else in the room, so take advantage of every opportunity to connect with them in that space, she advised. For many people, a hospitalization is a wake-up call and a medical crisis can be a powerful motivator, she added. Even patients who are not feeling their best can be surprisingly receptive to learning about their conditions and the changes they need to make to feel better, she said.

“When patients turn to television for entertainment and escape, you can passively expose them to health messaging at the same time, planting the seeds of awareness and interest,” she suggested. “When patients are ready to learn more, a video on-demand strategy allows you to deliver education on the most relevant and timely topics.

“Education is not only essential to improving outcomes; it is empowering for the learner,” she concluded. “When patients discover that they have choices and there are many things they can control about their conditions, they find new hope in recognizing that they are ultimately in charge of their own health.”

Twitter: @SiwickiHealthIT
Email the writer: bill.siwicki@himss.org
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