P3.C053: One-4-ALL Initiative: Innovation in Process and Technology to Address Health Disparities While Reducing Clinician Burden

Background: Low health literacy, or how well individuals can find, understand, and use information to inform health-related decisions for themselves and others, is associated with both racial/ethnic minority status and worse health outcomes. Over 1/3 of adults have limited health literacy. To address health literacy disparities in peri-operative care, we created a novel web-based educational app for families of patients undergoing gastrostomy tube (g tube) placement called One-4-ALL. We hypothesized that implementing an web-based educational app prior to g tube placement would be feasible and would provide appropriate perioperative education to families.

Methods: We partnered with Inside Out Medicine (IOM) to create a self-service web-based educational platform (One-4-ALL). We then conducted a prospective randomized controlled trial comparing One-4-ALL education to standard education for families undergoing g tube surgery at a single center from 6/2023-2/2024. Families randomized to standard education attended a one-hour course prior to hospital discharge Families randomized to One-4-ALL were given an online account to a web-based interface set to their preferred language and assigned a series of tasks at three times; 1. Before surgery, 2. Before discharge, and 3. Before clinic visit for tube exchange. Educational videos were embedded in the workflow and created to accommodate varying levels of health literacy. The study assessed the rate of completion of each One-4-ALL task. Families were asked to complete surveys after each time point. Comparisons were made between groups using Fisher’s exact test.

Results: We enrolled 58 patients: 28 randomized to One-4-ALL and 30 to standard education; 24 female (41%), 40 who identify as Non-Hispanic White (69%), 18 who identify as Hispanic (31%), 23 with Private insurance (40%), and 55 who prefer English (95%) (Table 1). Among those in the app group, 21 (75%) completed the pre surgery checklist, 13 (46%) completed the checklist prior to discharge and 10 (36%) completed the checklist prior to the first clinic visit for tube exchange. The majority of One-4-ALL families reported they felt comfortable deciding to elect for their child to receive a G tube (96%), that they know where to go to find information if they have questions (96%), they know what is involved with G tube surgery (83%), they know what to expect after surgery (83%), and what complications can occur (78%). No differences were seen between the One-4-ALL and standard education groups in response to these questions.

Conclusion: Self-service app-based perioperative education for families of patients undergoing G tube placement is feasible and provides information families need to make decisions with the same effectiveness as standard education. Completion of all modules in the app was low. Future work will aim to seek end user input to optimize the app and assess the impact of app-based education on provider burden.