(1173) Improving Enrollment and Adherence to the Lung Transplant Home Spirometry Program

PurposeIn May 2020, we implemented a home spirometry program (HSP) to facilitate remote monitoring of lung function in lung transplant recipients in response to the COVID-19 pandemic. We found enrollment and adherence rates were below the program goal of 75%. We developed a quality improvement project to optimize the HSP enrollment and onboarding in order to improve enrollment and adherence rates.MethodsGap analysis was performed through observation and qualitative interviews of patients, nurses, and physicians. A fishbone analysis found three main opportunities to improve adherence including a variable onboarding process, no foreign language offerings, and suboptimal educational material. We developed and launched a standardized workflow, a new educational video, and educational materials in 5 languages. In-process metrics were tracked through the use of an EMR “smartphrase” and QR code to indicate use of the new workflow and educational video. Enrollment and adherence were measured by the % of patients submitting more than one FEV1 value in the first 30 days after discharge.ResultsAfter implementation in August 2022, we found the new onboarding process, as indicated by the use of our“smartphrase”, and the new educational video, as indicated by the use of the QR code, were utilized for 100% of new patients over the first two months. We found an absolute increase of 85% of patients submitting an FEV1 value in the first month following discharge from lung transplantation (Figure 1).ConclusionWe were able to improve the process of onboarding and education through the development of a new standardized workflow and video. This was found to be reliably executed and resulted in an improvement in patient enrollment and adherence. Moving forward we will track the impact of our new onboarding and video educational tool on long-term adherence. In May 2020, we implemented a home spirometry program (HSP) to facilitate remote monitoring of lung function in lung transplant recipients in response to the COVID-19 pandemic. We found enrollment and adherence rates were below the program goal of 75%. We developed a quality improvement project to optimize the HSP enrollment and onboarding in order to improve enrollment and adherence rates. Gap analysis was performed through observation and qualitative interviews of patients, nurses, and physicians. A fishbone analysis found three main opportunities to improve adherence including a variable onboarding process, no foreign language offerings, and suboptimal educational material. We developed and launched a standardized workflow, a new educational video, and educational materials in 5 languages. In-process metrics were tracked through the use of an EMR “smartphrase” and QR code to indicate use of the new workflow and educational video. Enrollment and adherence were measured by the % of patients submitting more than one FEV1 value in the first 30 days after discharge. After implementation in August 2022, we found the new onboarding process, as indicated by the use of our“smartphrase”, and the new educational video, as indicated by the use of the QR code, were utilized for 100% of new patients over the first two months. We found an absolute increase of 85% of patients submitting an FEV1 value in the first month following discharge from lung transplantation (Figure 1). We were able to improve the process of onboarding and education through the development of a new standardized workflow and video. This was found to be reliably executed and resulted in an improvement in patient enrollment and adherence. Moving forward we will track the impact of our new onboarding and video educational tool on long-term adherence.