Koda Health Advance Care Planning (ACP) Platform

A personalized advance care planning platform utilizing the electronic health record to identify and invite patients.

The KODA Health Platform project brings the convenience of the preexisting Electronic Health Record (EHR) together with a personalized and non-judgmental cloud-based platform which tailors the Advanced Care Planning (ACP) dialogue to patient’s personalities and cultural backgrounds through machine learning.

This innovative technology promotes ACP conversations via the EHR to identify patients and send portal invitations to use Koda Health’s Advance Care Planning Platform.

Following conception, Koda Health and the Center for Healthcare Innovation (CHI) partnered together to perform a Phase 1 NSF-funded study.

Now complete, the outcome proved the efficacy of the digital platform. Showing that a platform that delivers personalized audiovisual content adapted to individual and cultural preferences of patients was successful.

With increasing deployment in health systems, the Koda Health platform will deliver a more differentiated dialogue as it interacts with, and learns from, more patients.

Looking Deeper

One of the societal trends accompanying longer lifespans and improved medical technology is a disconnect between many patients’ wishes and end-of-life care they receive. With 80% of Americans preferring to die at home, whereas only 31% do, it is evident that medical intervention in terminal cases can lead to overtreatment, which contributes up to $101 USD to medical care costs annually. This unwanted care goes against patients’ wishes and results in great costs to society, with more than 25% of Medicare spending accruing during the last year of life.

The existence of an Advanced-Care Directive (ACD) would dramatically reduce the impact on the families of those patients that face the decision to end continued life support, and those who prefer not to be kept alive in terminal intensive care situations will have their own wishes respected. This was exacerbated during the COVID-19 pandemic and emphasized the importance of ACD documentation.

ACDs ensure that care delivered to patients is in accordance with their goals and quality of life preferences, redirecting patients who prefer comfort care to the home and freeing up intensive care capacity.

Phase 1 Project Overview

This pilot study will have two paths for participants to take:

Path 1: will allow patients to go through the Koda Digital Health Platform by creating an account and using the groundbreaking technology to have their ACP conversations virtually.
Path 2: will have patients go through an ACP interview via a telephone visit led by Dr. Desh Mohan and Samantha Sanky to discuss this topic one on one.

Upon enrollment into the study, patients will be asked to complete a pre-assessment survey which includes a health risk assessment, ACP knowledge assessment, and an ACP readiness/previous experiences assessment. After a patient finished the pre-assessment survey and their initial path, they will be directed to a post-assessment survey. The post-assessment survey will re-assess their ACP knowledge, re-evaluate ACP readiness and previous experiences, and provide the opportunity for other feedback.

Once patients complete either path, they will have the option of completing the other path to compare which one seems to be better suited for their needs and ability. The patient will be able to have these important planning sessions completed and recorded so that their future wishes and goals are visible to others. The Patients who complete both paths will have the opportunity to complete an experience comparison survey which will compare the patient’s experience between using the digital ACP platform and the telehealth ACP interview.

CHI prides itself on bringing cutting-edge ideas and concepts to the clinical arena and using this technology to better the livelihood of individuals.

Research in end-of-life care is an area where CHI—and its members—have significant expertise. This led the leaders of CHI to travel to the Texas Medical Center and meet with the Koda Health team as their work in advance care planning was closely aligned to the Center’s interests and expertise.

Wake Forest Center for Healthcare Innovation and Koda Health have since developed a strong, working partnership that led to the submission of a grant through the National Science Foundation (NSF) Small Business Technology Transfer, which was awarded to both institutions.

Details of Study Process

Objectives of Study

The primary objective of this pilot study is to evaluate the reach and adoption of a Koda-based platform to conduct digital ACP. This will be studied in adult participants (age ≥ 50) to identify common motivators for completing ACP. Given that this is a pilot study, other parameters may be used for exploratory analyses.

Primary Objectives(s)

To evaluate the reach of a Koda-based ACP intervention among adults.
- Hypothesis: We hypothesize that 33% (1/3) of participants will click on the link to the Koda platform when administered through the MyWakeHealth patient portal

Secondary Objective(s)

To pilot test the adoption of a Koda-based ACP intervention among adults.
- Hypothesis: We hypothesize at least 50% of those who click on the link to the Koda platform will complete the Koda platform.
To examine a change in participant-reported knowledge of ACP from pre- and post-intervention.

Exploratory Objective(s)

To assess the usability of the digital, Koda-based ACP tool.
To identify clusters to detect participants’ personae regarding ACP, unbiased by gender, ethnicity, or social background.
To examine a change in participant-reported readiness of ACP from pre- and post-intervention
To evaluate user response affinity for virtual, Koda-based ACP platform compared to a telehealth ACP interview.

Outcomes of Study

Primary Outcome

Reach
- will be defined as the proportion of eligible subjects who click on the intervention link

Secondary Outcomes

Adoption
- will be defined as the proportion of participants who complete the Medical Care section in the Koda Health platform in Path One.
ACP Knowledge
- Participant-reported knowledge of ACP based on adapted and validated pre- and post-ACP intervention surveys
- Scores range from 1 (Not at all) to 5 (Extremely) with higher score determining better outcome

Exploratory Outcomes

Usability

Participant-reported usability of the digital ACP tool measured by the System Usability Survey (SUS)
Measured by the System Usability Scale (SUS) survey.
Measured by Likert Scale of strongly disagree, disagree, neutral, agree, and strongly agree.
A higher score equates to higher usability.

Persona Clusters

Participant’s response data will be clustered into four or more persona clusters based on ACP knowledge, ACP readiness, content preferences, gender, ethnicity, and social background.

ACP Readiness

We will examine the change in participant-reported readiness to complete.
Participant-reported readiness of ACP based on adapted and validated pre- and post-ACP intervention surveys.
Measured on a scale of 1-4 or 1-5 with a higher score indicating a higher level of readiness with one question being a descriptive measurement noting any change.

Preference for Virtual ACP platform vs Telehealth ACP Interview

Evaluate user response affinity for a virtual ACP platform in comparison to a telehealth ACP interview.
Measured on a Likert scale of strongly agree, disagree, neutral, agree, and strongly agree.
A higher score equates to a higher affinity for intervention.

Final Findings

Path 1

(Path 1) Initial Participant Enrollment Projection vs. Final Enrollment of Participants
Initial Projection -100
Total Participants Enrolled - 183

(Path 1) Post-Assessment Survey Completion (Goal vs. Actual Completion)
Goal - 100
Surveys Completed - 112

Path 2

(Path 2) Initial Participant Enrollment Projection vs. Final Enrollment of Participants Initial Projection
Initial Projection - 50
Total Participants Enrolled - 58

Experience Comparison Survey

(Both Paths) Experience Comparison Survey Goal vs. Total Completed)
Goal - 10
Surveys Completed - 42

Project Innovators

Jeff D. Williamson, MD, MHS

Director, Center for Healthcare Innovation
Director, Sticht Center for Healthy Aging and Alzheimer’s Prevention
Professor, Gerontology and Geriatric Medicine

Eric S. Kirkendall, MD, MBI

Co-Director, Center for Healthcare Innovation
Professor, Pediatrics - Hospitalists

Jennifer Gabbard, MD

Associate Professor, Gerontology and Geriatric Medicine

References

Parker, J. (2019) More Deaths Now Occur in Homes than Hospitals, Nursing Facilities. Hospice News. Retrieved from https://hospicenews.com/2019/12/12/more-deaths-now-occur-in-homes-than-hospitals-nursing-facilities/ on 16-June-2020.

Hwang, F., Kunac, A. (2018). Surgical Palliative Care, “Heroic Surgery,” and End-of-Life Care. In: Brown C., Inaba K., Martin M., Salim A. (eds) Emergency General Surgery. Springer, Cham. https://doi.org/10.1007/978-3-319-96286-3_44.

Shrank, W., Rogstad, T., Parekh, N. (2019) Waste in the US Health Care System – Estimated Costs and Potential for Savings. JAMA (Special Communication) 322(15):1501-1509. https://doi.org/10.1001/jama.2019.13978.

Cubanski, J., Neuman, T., Griffin, S., Damico, A. (2016). Medicare Spending at the End of Life: A Snapshot of Beneficiaries Who Died in 2014 and the Cost of Their Care. Kaiser Family Foundation Data Note. Retrieved from http://files.kff.org/attachment/Data-Note-Medicare-Spending-at-the-End-of-Life on 16-June-2020.

Li, R., Rivers, C., Tan, Q., Murray, M., Toner, E., Lipsitch, M. (2020). Estimated Demand for US Hospital Inpatient and Intensive Care Unit Beds for Patients With COVID-19 Based on Comparisons With Wuhan and Guangzhou, China. JAMA Netw Open 3(5):e208297. https://doi:10.1001/jamanetworkopen.2020.8297.

Kunz, R., Minder, M. (2020). COVID-19 pandemic: palliative care for elderly and frail patients at home and in residential and nursing homes. Swiss Med Wkly. 150:w20235. Doi:10.4414/smw.2020.20235.

Technology Transfer and Commercialization

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Research Focus Areas

Translation to Care

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Koda Health Advance Care Planning (ACP) Platform

Looking Deeper

Phase 1 Project Overview

Details of Study Process

Objectives of Study

Primary Objectives(s)

Secondary Objective(s)

Exploratory Objective(s)

Outcomes of Study

Primary Outcome

Exploratory Outcomes

Final Findings

Path 1

Path 2

Experience Comparison Survey

Project Innovators

Jeff D. Williamson, MD, MHS

Eric S. Kirkendall, MD, MBI

Jennifer Gabbard, MD

References