Researchers explored AI and NLP integration in post-acute patient engagement programs, addressing emotional, behavioral, and recovery barriers beyond SDOH. While SDOH data collection faces challenges, the study found 83% of U.S. acute care hospitals gather some SDOH data. NorthShore Division of Cardiology and Laguna Health’s research demonstrated that AI-enhanced interventions reduced readmission costs, emphasizing personalized solutions. Technology-aided coaching by transcribing conversations, identifying barriers, and scaling interventions for consistent care, applicable to chronic conditions beyond hospital transitions.
In a recent study, researchers explored the integration of AI and NLP in a patient engagement program following acute discharge. The aim was to address not only social determinants of health (SDOH) but also emotional, behavioral, and other obstacles that impede recovery.
While SDOH data plays a crucial role in patient outcomes, its application faces challenges due to a lack of standardization and equity concerns. To comprehend the routine collection and exchange potential of SDOH data, the Office of the National Coordinator for Healthcare IT examined data from the 2022 American Hospital Association Information Technology supplement. This initiative aimed to identify which non-federal acute care hospitals collect and use health-related social needs data from individual patients.
The study found that 83% of U.S. acute care hospitals gather some form of SDOH data, with 54% doing so routinely. The primary applications of this data include influencing clinical decisions, enhancing discharge planning, and facilitating referrals.
Although the ONC concentrates on measuring the adoption of validated screening tools aligned with CMS guidance, new research from the NorthShore Division of Cardiology and Laguna Health suggests that leveraging AI and NLP for integrating SDOH, mental health, and cultural factors could enhance post-acute recovery.
Their study focused on a cardiac patient management program that not only employed SDOH data but also considered the broader life context to provide behavioral and emotional support, thus improving outcomes within the first 30 days post-discharge. The research, published in the Journal of Healthcare Management’s July/August edition, highlighted substantial cost savings for patients who received additional support, as well as lower readmission costs.
Dr. Mark Lampert, Deputy Head of NorthShore’s Division of Cardiology, discussed how addressing life context beyond SDOH contributed to reduced readmission costs among participants.
Q: While screening identifies health-related social needs, effectively utilizing collected data remains challenging. How does focusing on “life context” enhance providers’ understanding of emotional, behavioral, and social factors, ultimately improving utilization?
A: Life context enables providers to grasp each patient’s unique circumstances, including social, financial, behavioral, and medical contexts. These factors often hinder recovery and remain undetected during hospitalization, discharge, or short outpatient visits.
Q: How was personalized behavioral and emotional support provided to individual patients in the study?
A: Upon engaging with the Laguna coach, patients underwent an assessment of their emotional and behavioral needs, identifying obstacles to recovery. Strategies were then tailored to overcome these barriers or provide professional guidance when necessary, aligning with each patient’s distinct situation.
Q: The study indicates the intervention’s reproducibility. How can technology facilitate scaling the approach?
A: Technology plays a vital role in alerting coaches to recovery barriers. Real-time NLP transcription of conversations enables AI to analyze dialogues and identify potential barriers. Coaches are alerted to address these concerns, creating a checklist of barriers to collaboratively devise solutions with patients.
Q: How does AI enhance the effectiveness of virtual care management platforms?
A: AI ensures consistency when scaling interventions to diverse coaches. The software used in the Laguna intervention trains, documents, and enhances coaching efficacy by analyzing coaches’ conversations and findings.
Q: Beyond improving hospital-to-home transitions, what other areas of care delivery can benefit from personalized virtual platforms?
A: The intervention holds potential across various care areas, such as chronic disease management (e.g., heart failure, chronic pain, diabetes, pulmonary disease).
