Whole-Person, Patient and Provider Centered Care in a Stressed-Out Healthcare Model

Evidence-based adjunctive care to help alleviate resourcing and stresses in our overburdened system

By Noel Pugh PhD, Alexa Abdelaziz PhD, Eziah Syed, Helene Rutledge, Goran Petrovic

We’ve now positioned Mend and our multimodal digital platform Upgraid across the stakeholders of American acute care delivery system. We’ve spoken with administrative and physician leaders at community-based tertiary facilities, for profit ASCs, wholly integrated IDNs and AMCs and physician groups large and small. No matter the size of facility, the community it supports or the strength of its leadership - we hear that we are “stressed out.” 

In a recent conversation with the President of a big system on the East Coast the pressure was palpable, “We are losing $1M per month, we can’t hire enough staff (particularly nurses), covid funds have dried up and elective surgery volume is 30% below historical.” 

This senior leader postulated: “all academic systems must currently be meeting the same fate.”

We challenge that Mend and the Upgraid  platform, will not only alleviate this stress, we believe we will transform to the care delivery model - both for patients and for providers.

And as evidenced by numerous systems quickly and eagerly partnering with Mend, healthcare leaders agree.

Hospitals are physically and psychologically taxing environments for many, where resources are thin and staff overworked. According to a study by Medscape, 76% of physicians report moderate to severe burnout, with the risk for burnout significantly higher among female than male physicians. Physicians have the highest rate of suicide of any profession — one in five has considered it — and women physicians are at a 400% higher risk of dying by suicide than women in the general population. A recent survey suggests that a full third of nurses plan on quitting their jobs in 2022. This doesn’t bode well for the remaining staff, who will feel further burdened in an understaffed environment, or the patients, whose level of care will inevitably be negatively impacted.  A nurse at an academic system responsible for patient prehab stated "I wish I could reach out to patients more than I'm able to."

We argue that even in the pre covid environment, our acute care delivery model had plenty of room for improvement. Given the utilization rates and cost structures, a true comprehensive approach with adjunctive multimodal care seemed an operational odyssey. And not because hospitals and care teams don’t want to provide a white glove experience and go the extra mile for their patients – they do, they just don’t have the bandwidth or the cost structure. And post covid, with labor shortages and severe stress on providers, this picture appears to be even more bleak.

A surgery is a major life event that places incredible emotional, psychological, physical and financial strain on the patient. Studies have shown that preoperative stress and anxiety is prevalent in 60%-80% of patients. Numerous large hospital studies have shown that as much as 50% of patients are undernourished at the time of care. Another study showed that postoperative cognitive dysfunction is prevalent in as many as 50%-80% of patients – this study concluded that surgery is “hard on the brain”. Finally, financially 60% of US persons filing for personal bankruptcy report medical bills as part of the reason.

From poor nutrition, sleep disturbance, worry/stress, lack of education, lack of support and poor adherence to protocols, there are a number of areas where we can improve and enhance the level of care provided to patients. This will drive better clinical outcomes and better financial outcomes for providers, payers and the patients. 

Mend will support and extend the current model with an adjunctive care delivery system that seamlessly fits into a hospital care plan while bridging care gaps burned out ambulatory providers cannot see

Our platform, called Upgraid, is the convergence of two innovations: 1) evidence-based precision clinical nutrition; and 2) a multimodal remote coaching and monitoring digital platform. This platform brings together evidence-based targeted precision nutrition with a whole person functional medicine approach to both patients as an adjunct to current care delivery, and to providers as an employee benefit.

There is now a mountain of published evidence supporting precision care models and a whole person functional medicine approach. 

Multimodal Care in Action

Patients are particularly vulnerable after a traumatic experience like surgery, and feelings like the loss of agency can impair recovery. Recent studies have correlated poor functional status and lack of social support as a reason for higher readmission rates.

Positive interventions can make measurable improvements. For example, prehabilitation before surgery is becoming utilized to improve the pre-operative physical conditioning of the patient. Meta analyses like this one in abdominal surgery has shown positive results from prehab.

Quality sleep is incredibly important for the healing process yet patients (50%+ according to this study) commonly develop significant sleep disturbances immediately following surgery, especially after a major surgery. These sleep disturbances can lead to postoperative adversities, including increased pain. There are a number of ways patients can be assisted with improving sleep, including dietary modifications, breathing and medication and practicing good pre-op sleep habits.

We know the healing power of nature. Studies have shown that time in nature can lower blood pressure and stress hormone levels, reduce nervous system arousal, enhance immune system function, increase self-esteem, reduce anxiety, and improve mood.

The same has been shown for the healing properties of music in a number of studies. This particular song was reported to reduce overall anxiety by 65% and 35% in usual resting states.

Perioperative nutrition now has a firmly established body of evidence. Put simply the body's metabolic demands are increased during trauma and better nourishment leads to better healing and outcomes. More targeted nutrition can be utilized to influence specific healing pathways such as preventing muscle catabolism.

None of these interventions present any downside risk, only upside. And if implemented well, they create patient experience and agency that not only improves outcomes but is truly differentiating.

But who in an overstressed acute care delivery pathway has the time to encourage patients to spend time in nature, listen to specific evidence-based music and address their at home nutrition while also monitoring this activity for outcomes and optimization?

Our Upgraid platform delivers this level of care. Mend provides two-way communication between the patient and our own in-house credentialed care team. Our clinical team guides the patient through the entire episode of care, handling guidance around stress, nutrition, sleep, lifestyle and other nodes, while directing specific clinical questions back to the physician and his/her care team. In this approach, we are an extension of the hospital and ambulatory care team.  Our business model allows us to provide a level of adjunctive support and at the same time alleviate pressure and cost. It's a business model enabled by the intersection of our two innovations.

And our design philosophy,  grounded in simplicity, allows for extreme ease of implementation and administration for the hospital system and  patient alike. 

Successful support of an overburdened system demands  utmost simplicity and ease of implementation  while delivering real results. Upgraid was born to answer this call and we’re very excited to work with the leading US hospitals to create a stepchange in acute care offerings – for patients and clinicians alike.

We've had resoundingly positive feedback on our approach and this is just some of what we've heard from hospitals so far:

Clinical coordinator: "this program should free up hours for us."

CEO of one of the largest orthopedic practices in the world: "love what you've built and the thought that has gone into the business model."

Service line leader in big academic system: "this approach aligns perfectly with where we want to go. We need to be a part of this."

President of large southern orthopedic practice: "truly does sound too good to be true."