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Centro Hospitalar Universitário de Santo António (University Hospital of Oporto)

Severe migraine: improving access while preventing emergency room admissions

Patient Initiated Follow-up (PIFU) empowers patients to detect red flags and helps providers to recognize early signs of decompensation and manage decompensation, reducing unnecessary appointments and preventable hospitalizations. Discover how UpHill increased CHUdSA capacity by applying this strategy through optimized and automated care journeys for severe migraine.


Red flags solved remotely


Patient adherence


Patient satisfaction

Traditional follow-up strategies, that use sequential and steady timeframes, disregarding the variable and unpredictable nature of clinical evolution, are leading to avoidable admissions in the Emergency Room. In fact, 25% of hospitalizations could be avoided with timely interventions, and around 40% of high-frequency ED users report chronic conditions.
In this scenario, Patient Initiated Follow-up gives patients the flexibility and convenience to report symptoms exacerbations and arrange their follow-up appointments when they most need them. (To go deeper on this topic have a look on our blog post.)
Centro Hospitalar Universitário de Santo António (CHUdSA) is a leading center with 4.900 professionals and 800 beds. With UpHill, CHUdSA implemented this approach for better managing patients with severe migraine, a condition that represents the leading cause of disability in people under the age of 50.

Project Goals

  • Identify migraine exacerbations timely;
  • Refer high risk patients to the appropriate level of care;
  • Prevent avoidable visits to the Emergency Department;
  • Empower patients on self-management;
  • Increase patient safety through close contact with the hospital team;
  • Improve clinical decisions based on the most up-to-date information;
  • Collect PROMS (Patient-reported outcome measures).


UpHill’s care orchestrator software was implemented and gave patients the ability to warn their health team about an exacerbation or worsening of symptoms, without overloading the emergency department or making an appointment that may prove unnecessary.
Once such mechanism was activated, follow-up questionnaires were automatically triggered enabling clinical teams to assess crises’ frequency, duration, and severity.
On the other hand, this solution has granted practitioners visibility of patients in exacerbation, enabling them to adjust the next steps in the journey accordingly. If crisis were of low risk, patients would receive recommedations. If crisis were of high rights a medical professional would either interact and adjust therapy or schedule an appointment for an earlier date.

Having a system in which the patient himself provides clinical information that is curated and interpreted, and having the ability to filter these alerts so that the clinical team isn't overwhelmed by such systems is extremely important.

Vasco Miranda, MD

Digital Health Lab Coordinator

Solution details and highlights:

  • Patient autonomy to report disease deterioration, using familiar patient channels (SMS, phone call and email).
  • No invasive medical devices or procedures.
  • Use of validated and automated questionnaires and scores.
  • Automatic alert generation to warn health teams on patients’ red flags.
  • Automatic patient stratification and recommendations on the next best actions.
  • Interoperability capabilities linking different systems reducing tasks repetition.
  • Compliant with relevant industry-standard certifications.

The visibility it provides over the entire patient journey, the fact that alerts are always delivered by email and that one can view the platform on the mobile phone are all aspects that make UpHill useful for nursing teams in charge of monitoring chronically ill patients.

Bárbara Oliveira


Impact and insights:

  • 95% patient adherence.
  • ~ 80% of patients feel that this service has enabled faster resolution of migraine-related pain episodes.
  • 85% of patients consider that the mechanism facilitates their access to the healthcare teams and makes them feel safer and more secure in self-management.
  • 23% of patients initiated a follow-up at least once.

The project will certainly bring return of investment to the hospital. These products are highly scalable.

Rita Veloso

Executive Board Member

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