Clin-STAR Journey Story

Pioneering Mobile Health to Prevent Delirium: From Patient Experience to Systemic Change

Heidi L. Lindroth, PhD, RN, is an Assistant Professor in the Department of Nursing at Mayo Clinic in Rochester, MN. Her career has centered on understanding, predicting, and preventing delirium. In fact, her vision is to help create “a world without delirium.” Her dedication to this goal was solidified by a chance encounter during her doctoral research.

“I had a participant who changed my entire career,” she said. Dr. Lindroth met this individual while conducting patient study assessments before and after elective surgery. Like all patients enrolled in her study, she met with this person every day after the surgery while he was in the hospital. “He had severe delirium for 21 days,” she said. At their follow-up appointment a year later, the lasting cognitive impairment changed the trajectory of this otherwise healthy person’s life. “It was the most severe delirium I’ve ever seen—still to this day.”

What proved perhaps more distressing, this encounter brought to light critical gaps in clinical practice. When Dr. Lindroth reviewed this participant’s medical record, she discovered that delirium was not documented, nor were any interventions. “Nothing was charted,” she said. “We have evidence-based practices to detect delirium and we have evidence-based practices to prevent it. Apparently, we didn’t use them very well.”

Motivated by this experience, Dr. Lindroth developed iPREPARED, a mobile health application. The app empowers care partners—whether family members, friends, or others—to actively engage in delirium prevention strategies with the patient during hospital stays. Thanks to pilot funding from Clin-STAR, the initial feasibility and acceptability study opened at Mayo Clinic in 2021. “We recruited 30 patient-care partner pairs from the emergency room,” she said. “The initial feedback was positive, and based on that feedback, we updated the app and conducted another successful pilot, internally funded at Mayo,” she said.

The iterative development process of iPREPARED resulted in recent submission of an R01 application to the National Institute on Aging. The project aims to study and refine the app with 2,400 patient-care partner pairs from three institutions in Minnesota and Indiana. This grant will allow us to diversify the study population across race and urban/rural residence. “My goal is to make iPREPARED publicly available so any patient or any person can know about delirium and what they can do to prevent it,” she said. “This R01 will help us get there.”

Clin-STAR has been instrumental in shaping both her research and her professional growth. “My mentor from Clin-STAR has been pivotal,” she said about Malaz A. Boustani, MD, at Indiana University, one of the research sites for the R01. She and Dr. Boustani continue to meet weekly, beyond their official Clin-STAR mentoring relationship. “Without Clin-STAR, this work wouldn’t be where it is. I’m incredibly grateful.”

Beyond formal mentorship, Dr. Lindroth recalled a spontaneous connection that occurred during the virtual Clin-STAR annual meeting in 2020. “I was in the Shark Tank session doing my pitch. A senior scientist, Dr. Chris Carpenter, who I didn’t know, said he ‘knew someone at the Mayo emergency department who might be interested’ in what I was doing,” she said. “He connected me with Fernanda Bellolio, and we’ve been collaborating ever since.” A few years later, Dr. Carpenter also moved to Mayo, and they began working together. “I met my collaborators at Mayo through Clin-STAR,” she said. “It’s roundabout, but it’s been huge for my career.”

Participating in the Clin-STAR annual meetings provided Dr. Lindroth with networking opportunities and collaborative insights. “You get to meet people who are in a similar spot to you and hear about their ideas and their research—what worked and what didn’t,” she said. “As a smaller conference, it had a lot of different networking events and opportunities to connect with people, but also structured content to help you along in your career.”

Dr. Lindroth now helps others along in their careers as co-chair of Clin-STAR’s Delirium Interest Group. This group offers a place to foster collaboration and knowledge exchange among junior and senior investigators alike. “It’s a great platform for learning and sharing resources and ideas,” she said.

In the spirit of giving back, Dr. Lindroth recommends Clin-STAR “to every single junior investigator who’s interested in aging” as a catalyst for career advancement. “The program provides resources to obtain foundational data for securing larger grants,” she said, highlighting the program’s support for early-career clinician scientists. “Clin-STAR gave me the opportunity to get preliminary data, which led to submission of a larger NIH grant application. I wouldn’t have been able to do this without Clin-STAR. The program plays a critical role for junior investigators.”