- 15% reduction in average systolic blood pressure within 3 months
- 1 point reduction in HbA1c
- 5-10-fold reduction in admin time, 75% reduction in clinical time
- 30-day readmissions down 66% for CHF, 75% fewer hospitalizations for diabetes
Better managing patients with multiple chronic conditions is becoming critical – both for patients’ quality of life and for purely economic reasons for health plans and ACOs.
Here we explore why Florence the AI Nurse is so successful in managing multimorbid patients with a particular focus on the increasingly large cohort suffering from both diabetes and hypertension (Co-DM&HTN). In the US more than 38 million adults have diabetes (90-95% type 2) and studies, including A Long et al, suggest 75% of these adults are also hypertensive.
Multiple studies have shown Florence’s ability to reduce A1c by 1 point while reducing blood pressure by 15% moving large cohorts into control. Florence is proven to reduce hospital admissions by 75%. While some studies have suggested saving as much as 75% of clinical time due to Florence automation (from diagnosis, through titration to BP control).
How does Florence the AI Nurse work? Via Text.
Think of Florence as a friendly and competent member of the care team. ‘She’ proactively engages, manages, and monitors patients via two-way text messaging. She is in regular contact with patients and notifies her (human) colleagues when appropriate.
Florence’s clinical conversations with patients are governed by evidence-based protocols and powerful AI.
By using text messaging that works on any cell phone, Florence reaches patients where they are; no complicated app to download or internet access required. According to Pew Research 97% of all adults own a cell phone and 81% of over 65-year-olds use text messaging rising to 92% of the over 50s.
Engagement Success: In patient’s language, personalized, helpful
Florence knows the patient and their conditions. She communicates in English or Spanish, she is empathetic and knowledgeable. 97% of patients find Florence “easy to use” and we typically achieve engagement scores of around 80%. Florence ensures patients feel connected to their care manager or clinic (without using expensive and scarce human resources). Her feedback and non-judgmental responses reassure and encourage self-management; the ability for patients to ask questions and their responses break down historic barriers to engagement; reasons for non-adherence are better understood, SDoH context is established.
Education Success: personalized, real-time feedback leading to better habits
Improving health literacy is critical in the management of high-risk patients. Florence helps patients to form better habits, for example by checking medication adherence (providing feedback and support and resources if non-adherent). For patients experiencing hypoglycemia, she will advise on what foods or snack to take and check in 15 or 20 minutes later. A study showed that 87% of patients with CHF and HTN felt they understood their condition better.
Care Plan Adherence: Frequent check-ins between visits, notifies care team if appropriate
Florence’s messages and reminders are “what a nurse would do if they had all the time in the world”. For newly diagnosed or unstable patients she may check in several times a week regarding medication or asking for readings ensuring a finely tuned balance to maximize engagement and patient adherence without creating alert fatigue. She notifies the care team according to the patient configuration reflecting their comorbidity and relevant context.
Clinical Team Success: Avoid burn-out, automation & only connect when it matters
It is near impossible for a human working in a hectic, pressurized environment to deliver important but not urgent highly personalized day-in and day-out routine care management. Instead, Florence is the “mini-me in their pocket”. Clinicians value Florence working tirelessly 24/7, keeping them informed with data and only escalating when appropriate. This ensures well-informed clinicians with better data having fewer but more fulfilling patient encounters. Florence not only reduces clinical inertia, but studies have shown Florence can free up 75% of clinical time and reduce admin time five to ten-fold.
Overview of Florence Co-DM&HTN Protocol
Florence has evidence-based protocols that cover all stages of disease progression for patients from ‘Newly Diagnosed & Unstable’ to those patients that are ‘Stable & Engaged’.
For Newly Diagnosed & Unstable Florence focuses on education and the importance of medication adherence, encouraging the patient to better self-manage. This is achieved by real-time feedback (“your blood sugars are low, consider eating a snack and let’s take another reading in 15 minutes”) and bite-size education (avoiding salty foods, moderate activity, etc). During this phase Florence typically engages with the patient one to three times per day.
Once a patient is stable and is adopting better, healthier habits, Florence can move to a less intense phase of longer-term monitoring. Florence typically checks in with the patient once or twice per week.
When implementing Florence, protocols will be refined and configured to your cohort and pathway/workflow. Protocols can be configured at an individual patient level, but in most cases, we focus each protocol on a specific cohort.
See below for a list of typical components (we call these templates) that make up a Co-DM&HNT Protocol for a ‘Newly Diagnosed & Unstable’ patient cohort:
| Template | Objective / Frequency |
|---|---|
| Introduction | Set patient expectations, including duration, how to ask for help, etc. |
| Blood Glucose Readings | Daily with immediate feedback, trends, escalation thresholds |
| Blood Pressure Readings | 2 x week with immediate feedback, trends, escalation thresholds |
| Medication Adherence | Daily with feedback, escalation thresholds |
| Mood Score | 2 x week, access to support material, escalation thresholds |
| Coaching | 3 x week rotating, food (avoid salt/sugar), activity, wellbeing |
| Request for Assistance | Florence will respond as configured 24/7, including escalation if required |
| Questions | Florence can answer questions 24/7 re health or clinic logistics |
Want to learn how Florence can support your Co-DM&HTN Population?
Visit www.generatedhealth.com
Contact
US: Eric Bender at ebender@generatedhealth.com
UK: Kylie Dentith at kylie.dentith@generatedhealth.com
Australia: John Griffiths at john.griffiths@generatedhealth.com
References:
- Boersma, P., Black, L., & Ward, B. (2020). Prevalence of Multiple Chronic Conditions Among US Adults, 2018. CDC Preventing Chronic Disease.
- Long, A., & Dagogo-Jack, S. (2011). Comorbidities of diabetes and hypertension: mechanisms and approach to target organ protection. Journal of Clinical Hypertension.
- Tsimohodimos, V., Gonzalez-Villalpando, C., Meigs, J., & Ferrannini, E. (2018). Hypertension and Diabetes Mellitus: Coprediction and Time Trajectories. AHA/ASA Journals.
https://www.pewresearch.org/internet/fact-sheet/mobile/?tabItem=5b319c90-7363-4881-8e6f-f98925683a2f
