Becker's Clinical Quality & Infection Control

13 QUALITY IMPROVEMENT & MEASUREMENT Ascension drives quality, access wins with 'digital nudges' By Erica Cerutti O ver the past few years, Ascension has increased mammograms by 10,000 and colon cancer screenings by 40,000 by using text-based "digital nudge" programs that prompt patients to schedule and complete care. The St. Louis-based system is now building on those results by applying a similar approach to chronic disease management, maternal care and medication adherence, Thomas Aloia, MD, executive vice president and chief clinical officer, told Becker's. Across the screening campaigns, the digital nudge programs have driven a 60% increase in patient engagement compared to traditional communication methods, he said. "While we're pulling all the levers with our physicians and nursing colleagues to educate patients one-on-one, we've got these overarching digital programs that are really game changers." The campaigns rely on behavioral nudges delivered via text message, reminding patients to schedule appointments and follow through on care. Leaders say the format allows Ascension to automate outreach and reach patients at scale, while aligning with how many prefer to communicate. The system structures these efforts as three-year initiatives, giving teams time to measure outcomes and refine operations before expanding into new focus areas. With its breast and colon cancer screening programs nearing the end of that cycle, Dr. Aloia said Ascension is now shifting attention to additional use cases. This year, the health system introduced digital nudges aimed at improving blood pressure and glucose control in patients with diabetes. The program collects patient responses and escalates concerning readings, such as elevated blood pressure, to care teams for follow-up. Additionally, Ascension is applying the same approach to medication adherence. Patients receive reminders to take prescriptions and confirm they have access to medications, with the option to opt in or out of the program. The initiative is also available to Ascension employees through its health plan. The system is now bringing its digital nudge strategy into maternal care with the goal of keeping new mothers connected to care in the first 30 days after returning home following delivery. The postpartum program began in a single market in Florida and is now being expanded systemwide. Patients receive a series of text messages prompting them to check in on their physical and emotional health, identify warning signs and seek follow-up care when needed. "We've seen 23% of those patients have a concern that was solicited through the text-based program, and then we connect them to their obstetrician or their primary care providers," Dr. Aloia said. The effort is aimed at closing gaps in postpartum care, a period when complications can arise and follow-up often drops off. In Florida, the program improved follow-up visit rates and strengthened ongoing engagement between patients and their care teams. Much of this work is now housed within Ascension's Clinical Innovation Institute, which launched late last year to bring together clinical innovation programs, graduate medical education and research under a single structure. The institute also serves as a centralized pathway for evaluating and scaling new technologies across the system. Looking ahead, Ascension plans to pair its digital engagement strategy with new investments in continuous patient monitoring. The system is preparing to pilot a program in Tennessee that employs wearable biosensors to track patients' vital signs in real time during hospital stays and after discharge. Dr. Aloia said continuous monitoring may support earlier detection of clinical changes while also identifying patients who are stable enough for shorter hospital stays. Unlike traditional monitoring, which captures vital signs a few times per day, the technology will enable clinicians to collect data hundreds of times daily, offering a more comprehensive view of a patient's condition. The approach could also reduce reliance on more costly post-acute care settings by allowing patients to recover at home with ongoing oversight. "We believe monitoring patients for a seven- to 30-day period is going to substantially increase the safety and confidence level to send people back home, which, of course, is always our goal," he said. n " While we're pulling all the levers with our physicians and nursing colleagues to educate patients one- on-one, we've got these overarching digital programs that are really game changers." - Dr. Thomas Aloia

• Cover