Project Spotlight: eMCARE

Many young adults in the United States are not well prepared for the transition from pediatric to adult care, evidenced by high rates of costly and, often, preventable health problems. Young adults tend to forego seeking routine and preventative primary care (PC), instead presenting to emergency department (ED) or urgent care centers with acute problems. ED providers have neither time nor training to address most health issues identified during treatment and typically recommend primary care follow-up. Unfortunately, per local and national statistics, approximately 70% of these patients never follow-up. eMCARE is an automated text messaging (app-based) system to promote the participation of young adults in routine primary care after an ED or urgent care visit. eMCARE will conduct a brief, automated, and tailored dialogue with participants to optimally promote PC engagement. Connecting young adults to PC via a system like eMCARE that can be easily integrated into healthcare delivery will address the need and reduce costs associated with annual, preventable healthcare.

Please share a little about your background and research experiences.

Trained in clinical and developmental psychology, Dr. Dana Rofey’s work focuses on key research areas related to psychosocial aspects of adolescent and young adult (AYA) health. Her focus has been on preventative and intervention efforts to assist AYA in increasing functional aspects of their lives. Over the past decade, her lab has developed and used innovative technologies such as texting platforms, actigraphy, and ecological momentary assessment to promote adherence to treatment, as well as implementation of evidence-based practices. She has worked on federally and foundation-funded grants with community stakeholders tailored for youth at elevated risk for challenges as they transition to adult care. This project—eHealth Mobile Technology Connecting Young Adults to Routine Engagement (eMCARE)—investigates the effectiveness of a reward-based, SMS-messaging system to engage young adults in primary care as a logical next step in marshaling our team’s expertise in adolescent behavior change, innovative technology interventions, and integrated behavioral and primary care.

What led you to the PHDA:

Among the PHDA’s stated aims are the movement from data to patient solutions, disease prevention, and enhanced care. eMCARE is an adaptive, automated text messaging and app-based system built on patient data and designed to promote participation that aligns with PHDA goals. The system incentivizes young adults to use preventative care and to connect to a medical home with the ultimate goal of improving patient outcomes. eMCARE is a dynamic collaboration between the University of Pittsburgh Innovation Institute, sciVelo, UPMC Enterprises, UPMC Western Behavioral Health, and UPMC Children’s Hospital of Pittsburgh (CHP). All parties involved have invested in eMCARE with the shared goal of efficiently putting science to work for human well-being.

We were excited by PHDA’s unique ability to bring business model expertise to the science. We realize that building a successful business model is essential to our goal of helping young adults, particularly with a new approach such as eMCARE.

Walk us through your project:

The eMCARE concept is a two-way, adaptive, automated text messaging and app-based system to promote AYA participation in routine primary care after an emergency department (ED) or urgent care visit. eMCARE will conduct brief automated text messaging-based dialogue with participants post-ED discharge. eMCARE will tailor messaging and feedback to each individual based on a number of factors in order to optimize the likelihood of PC engagement. The goal of the current work is to answer the following question: Can we identify distinct personas of ED users who would benefit most from eMCARE? Future work will include testing the impact of eMCARE on reducing repeat ED visits and improving health outcomes.

How do you and your project partners’ strengths complement each other?

Dr. Dana Rofey is a clinical psychologist and health behavior change researcher with extensive clinical and research experience working with adolescents and young adults. Dr. Elizabeth Miller is the Director of Adolescent and Young Adult Medicine with extensive intervention research experience in dissemination and implementation science. Dr. Clif Callaway is an emergency medicine doctor attempting to optimize innovative outcomes for YA in the ED. Dr. Mayank Goel is a machine learning expert who is well-versed in adapting technology for personalized medicine. Mr. John Lovelace is the President of UPMC for You and also President of Government Programs and Individual Advantage Products at the UPMC Health Plan. Mr. Lovelace has been instrumental in informing the team of Health Plan initiatives and areas in which eMCARE can be advantageous to Health Plan members. The technology team is led by Mr. Sam Shaaban, founder of web technology development firm NuRelm. The role of NuRelm’s team is to develop eMCARE’s delivery and data management technology, research the market, and develop/validate the business model. In addition to these key personnel, Youth Research Advisory Board of the CHP Division of Adolescent and Young Adult Medicine will be actively involved as key stakeholders in this project.

In what ways has UPMC played a role in lending clinical expertise and sharing data?

UPMC has played an integral role in providing clinical expertise and sharing the data that is the foundation of the eMCARE application. Our initial idea was supported by an award from Pitt Innovation Challenge (PinCh). After PinCH, we collaborated with the Children’s Hospital of Pittsburgh, Adolescent and Young Adult Medicine (Dr. E. Miller), Emergency Department (Dr. S. Srinivasan), and the Youth Advisory Clinic. This provided a prototype alongside NuRelm (S. Shaaban) that was the basis for an NIH Small Business Grant (STTR, Phase I).

In our Phase I STTR, we have had the good fortune to work with Mr. John Lovelace to learn more about the factors that drive repeat ED visits. We then paired with the interdisciplinary researchers of UPMC Emergency Departments (Drs. C. Callaway and S. Srinivasan) to test whether eMCARE could shift young adults’ decision-making to establish routine care. We investigated the feasibility of eMCARE; this provided the basis for the current UPMC Enterprises/PHDA funding. This funding has provided the opportunity to collaborate with The Pitt Clinical and Translational Science Institute (CTSI) and the Health Record Research Request (R3) – an electronic medical record data warehouse. We are working with the R3 team to retrieve de-identified patient records from across UPMC emergency departments to carry out our work.