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Healing at Home

Healing at Home

Supporting new mothers in the fourth trimester

Project status

Implementation
Scale

Collaborators

Kirstin Leitner, MD 

Lori Christ, MD 

Joana Parga-Belinkie, MD 

Laura Scalise, MSN, RN 

Jessica Gaulton, MD, MPH

Innovation leads

Funding

Innovation Accelerator Program 

Johnson & Johnson Maternal Health QuickFire Challenge 

Penn Medicine Women’s Health Leadership Council 

Independence Blue Cross

External partners

Memora Health

Philadelphia Department of Public Health

Opportunity

The postpartum length of stay (LOS) for a routine vaginal delivery is typically three days. That may not sound like a long time; however, many new parents want to be in the comfort of their own homes, recovering and bonding with their babies as quickly as possible after delivery. In fact, a 2018 survey at the Hospital of the University of Pennsylvania (HUP) found that 80 percent of low-risk patients who had vaginal deliveries were amenable to going home one day sooner. 

Regardless of when discharge occurs, numerous challenges can arise in the weeks following birth, also known as the fourth trimester. Clinical considerations during this time are complex. Patients can experience everything from typical recovery symptoms to potentially dangerous complications that can lead to death. 

In 2018, when this project began, the American College of Obstetricians and Gynecologists (ACOG) released new guidelines advising that postpartum care should become an ongoing process rather than a single encounter, with services and support tailored to each patient's individual needs.

Intervention

Healing at Home supports the postpartum needs of parents and babies in the setting they prefer using a two-pronged approach. 

First, the program gets eligible patients home sooner by implementing an expedited discharge process. Historically, health screenings have been completed for new babies 36 hours after birth. Healing at Home moves screening up to 24 hours, enabling patients and their babies to be ready for discharge one day after delivery rather than two. 

Next, Healing at Home introduces a text-based automated postpartum chatbot that bridges the gap in fourth-trimester care by providing new parents with around-the-clock access to clinical guidance. The chatbot fields questions and concerns, provides just-in-time education, facilitates more efficient lactation support and postpartum depression screening, and escalates triage to higher-value care if necessary.

Impact

During initial pilots at HUP, Healing at Home safely decreased LOS by 40 percent, with zero postpartum emergency department visits or readmissions among participants. And an analysis conducted by the team showed that the program's automated chatbot correctly and automatically answered 80 percent of patient inquiries – giving parents peace of mind and reducing the burden on busy providers so that they could focus on more acute issues. 

Based on these results, Healing at Home was implemented as a clinical program at HUP in March 2020. 

Currently, the team is working on expanding and enhancing the program. Efforts include:

  • Piloting at Pennsylvania Hospital and other Penn Medicine hospitals,
  • Development of a Spanish version of the program,
  • Expansion of clinical content to support patients delivering babies who were born preterm,
  • And piloting a long-term postpartum depression screening pathway that follows participants' mental health for one year.

At scale, Healing at Home has the potential to improve the postpartum experience for more than 16,000 Penn Medicine patients annually, setting the stage for the long-term health and well-being of new parents and their babies.

Innovation Methods

A day in the life

One of the best ways to learn more about a problem area is to experience it yourself. Immerse yourself in the physical environment of your user. Do the things they are required to do to gain a firsthand experience of...

A day in the life

We spent many hours on postpartum floors talking to patients to understand their pain points. A common theme was that most people we spoke to, 80 percent in fact, wanted to leave the hospital sooner than they were scheduled to. We also spent several hours observing new mothers in their homes to learn about what type of support is needed in the...

A day in the life

One of the best ways to learn more about a problem area is to experience it yourself. Immerse yourself in the physical environment of your user.

Do the things they are required to do to gain a firsthand experience of the challenges they face. Completing a day in the life exercise will enable you to uncover actionable insights and build empathy for the people you're hoping to help.

A day in the life

We spent many hours on postpartum floors talking to patients to understand their pain points. A common theme was that most people we spoke to, 80 percent in fact, wanted to leave the hospital sooner than they were scheduled to.

We also spent several hours observing new mothers in their homes to learn about what type of support is needed in the first few weeks after delivery.

Fake back end

It is essential to validate feasibility and understand user needs before investing in the design and development of a product or service. A fake back end is a temporary, usually unsustainable, structure that presents...

Fake back end

We piloted a fake back end to evaluate whether postpartum parents would utilize text-based support. To test this in a low-cost way, we manually interacted with the patients, mimicking what interactions with a chatbot might look like. Over two months, 90 patients sent more than 2,000 messages to the text message support team. The pilot revealed...

Fake back end

It is essential to validate feasibility and understand user needs before investing in the design and development of a product or service.

A fake back end is a temporary, usually unsustainable, structure that presents as a real service to users but is not fully developed on the back end.

Fake back ends can help you answer the questions, "What happens if people use this?" and "Does this move the needle?"

As opposed to fake front ends, fake back ends can produce a real outcome for target users on a small scale. For example, suppose you pretend to be the automated back end of a two-way texting service during a pilot. In that case, the user will receive answers from the service, just ones generated by you instead of automation.

Fake back end

We piloted a fake back end to evaluate whether postpartum parents would utilize text-based support. To test this in a low-cost way, we manually interacted with the patients, mimicking what interactions with a chatbot might look like.

Over two months, 90 patients sent more than 2,000 messages to the text message support team. The pilot revealed patients' most common questions and concerns - providing us with a framework for building an automated chatbot to support families in the fourth trimester.