Caring for patients at home: Achieving optimal outcomes

There are thousands of wellness apps, hundreds if not thousands of devices, apps and tools that can be used for chronic disease management, all of them adding their streams to the healthcare data ocean. 

The Apple Watch captures the wearer’s heart rate and, in a study with Stanford, demonstrated the ability to identify atrial fibrillation. Because Afib can lead to a stroke, identification by an Apple Watch is likely to lead people to their doctor’s office for formal diagnosis and treatment.

But what is the implication of this new technology if the early identification leads to unnecessary interventions that lead to unintended complications and worse outcomes? This is not a far-fetched issue. It seems counterintuitive to not pursue screening when the technology exists, but health care has many examples of promising new technologies that failed to deliver improved outcomes.

The U.S. Preventive Services Task Force puts new screening tests through rigorous scientific process to make sure that the benefit outweighs the risks.  From their recommendations:

On breast cancer screening:

“While screening mammography in women aged 40 to 49 years may reduce the risk for breast cancer death, the number of deaths averted is smaller than that in older women and the number of false-positive results and unnecessary biopsies is larger.” Accessed 11/15/19

On prostate cancer screening:

“Screening offers a small potential benefit of reducing the chance of death from prostate cancer in some men. However, many men will experience potential harms of screening, including false-positive results that require additional testing and possible prostate biopsy; overdiagnosis and overtreatment; and treatment complications, such as incontinence and erectile dysfunction.” Accessed 11/15/19

We’re in an interesting place regarding technological advancement and data. Much work needs to be done to validate that the information leads to results we want. With robust risk-adjustment methodologies we have the tools to assess impact, measure results and understand which people are most likely to benefit from new technologies.

Dr. Juggy Jagannathan delves into these issues and more as we discussed ways to improve health and health care on the Inside Angle podcast.

L. Gordon Moore, MD, is Senior Medical Director, Clinical Strategy and Value-based Care for 3M Health Information Systems.