Subscribe to RSS
A Digital Health Intervention to Improve the Clinical Care of Inflammatory Bowel Disease PatientsFunding This study was funded by the University of California San Francisco Digital Patient Experience Program.
Background Inflammatory bowel disease (IBD) is a chronic condition that requires close monitoring. Digital health virtual care platforms can enable self-monitoring and allow providers to remotely surveil patients and efficiently identify those with active disease.
Objectives The primary aim was to design and implement an IBD remote monitoring program, identify predictors of patient engagement, and determine who found the chat to be a valuable tool.
Methods We developed the IBD Virtual Care Chat, an electronic health record (EHR)-integrated chat to monitor electronic patient reported outcomes (ePROs), medication changes, and disease activity, and subsequently report concerning findings to providers via the EHR. All patients in the IBD practice over age 18 with a clinical encounter in the preceding 12 months were eligible to be enrolled. The primary aim was to identify predictors of patient engagement and determine who found the chat to be a valuable tool.
Results Between May 2021 and March 2022, 2,934 patients were enrolled. A total of 1,160 engaged at least once and 687 (23.4%) continually engaged, submitting at least three ePROs. Disease severity (based on Harvey–Bradshaw Index or Simple Clinical Colitis Activity Index) did not impact ePRO submissions. Patients were significantly more likely to be continually engaged if they self-reported the presence of extraintestinal manifestations (7%, 95% confidence interval: 0.01–0.14; p = 0.04). Patient satisfaction remained moderately high with a median score of 8 (interquartile range: 5–10) on a scale of 1 (poor) to 10 (good).
Conclusion Our program demonstrates the potential for EHR-integrated digital health as part of routine IBD care to achieve sustained engagement with high patient satisfaction.
Protection of Human and Animal Subjects
This study was approved by the institutional review board.
R.C.: Conceptualization, data curation, formal analysis, investigation, writing—original draft, writing—review and editing; A.W.L.: project administration, data curation, formal analysis, investigation, writing—original draft, writing—review and editing; Y.I.: data curation, resources; O.B.: funding acquisition, conceptualization, methodology, project administration; A.M.: conceptualization, investigation, visualization; E.M.: funding acquisition, project administration; L.P.: data curation, formal analysis, review and editing; A.Y.O.: funding acquisition, resources, conceptualization, methodology, investigation, formal analysis, writing—review and editing, supervision; U.M.: conceptualization, methodology, investigation, writing—review and editing, supervision.
Received: 08 February 2023
Accepted: 14 August 2023
Accepted Manuscript online:
16 August 2023
Article published online:
25 October 2023
© 2023. Thieme. All rights reserved.
Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany
- 1 Ye Y, Manne S, Treem WR, Bennett D. Prevalence of inflammatory bowel disease in pediatric and adult populations: recent estimates from large national databases in the United States, 2007-2016. Inflamm Bowel Dis 2020; 26 (04) 619-625
- 2 Barnes EL, Loftus Jr. EV, Kappelman MD. Effects of race and ethnicity on diagnosis and management of inflammatory bowel diseases. Gastroenterology 2021; 160 (03) 677-689
- 3 Yin AL, Hachuel D, Pollak JP, Scherl EJ, Estrin D. Digital health apps in the clinical care of inflammatory bowel disease: scoping review. J Med Internet Res 2019; 21 (08) e14630
- 4 Avery P. Using e-health tools and PROMs to support self-management in patients with inflammatory bowel disease. Br J Nurs 2021; 30 (07) 394-402
- 5 Ankersen DV, Noack S, Munkholm P, Sparrow MP. E-Health and remote management of patients with inflammatory bowel disease: lessons from Denmark in a time of need. Intern Med J 2021; 51 (08) 1207-1211
- 6 Nguyen NH, Martinez I, Atreja A. et al. Digital health technologies for remote monitoring and management of inflammatory bowel disease: a systematic review. Am J Gastroenterol 2022; 117 (01) 78-97
- 7 Zhen J, Marshall JK, Nguyen GC, Atreja A, Narula N. Impact of digital health monitoring in the management of inflammatory bowel disease. J Med Syst 2021; 45 (02) 23
- 8 van Erp LW, Groenen MJM, Heida W, Wisse J, Roosenboom B, Wahab PJ. Mobile application to monitor inflammatory bowel disease patients on intravenous biologic treatment: a feasibility study. Scand J Gastroenterol 2021; 56 (12) 1414-1421
- 9 Harvey RF, Bradshaw JM. A simple index of Crohn's-disease activity. Lancet 1980; 1 (8167): 514
- 10 Walmsley RS, Ayres RC, Pounder RE, Allan RN. A simple clinical colitis activity index. Gut 1998; 43 (01) 29-32
- 11 Rural-Urban Commuting Area Codes. Economic Research Service U.S. Department of Agriculture; 2020
- 12 Kind AJH, Buckingham WR. Making neighborhood-disadvantage metrics accessible - The Neighborhood Atlas. N Engl J Med 2018; 378 (26) 2456-2458
- 13 Golinelli D, Boetto E, Carullo G, Nuzzolese AG, Landini MP, Fantini MP. Adoption of digital technologies in health care during the COVID-19 pandemic: systematic review of early scientific literature. J Med Internet Res 2020; 22 (11) e22280
- 14 Murray E, Hekler EB, Andersson G. et al. Evaluating digital health interventions: key questions and approaches. Am J Prev Med 2016; 51 (05) 843-851
- 15 Kontos E, Blake KD, Chou WY, Prestin A. Predictors of eHealth usage: insights on the digital divide from the Health Information National Trends Survey 2012. J Med Internet Res 2014; 16 (07) e172
- 16 Ratcliff CL, Krakow M, Greenberg-Worisek A, Hesse BW. Digital health engagement in the US population: insights from the 2018 Health Information National Trends Survey. Am J Public Health 2021; 111 (07) 1348-1351
- 17 Haynes SC, Kompala T, Neinstein A, Rosenthal J, Crossen S. Disparities in telemedicine use for subspecialty diabetes care during COVID-19 shelter-in-place orders. J Diabetes Sci Technol 2021; 15 (05) 986-992
- 18 Xie Z, Liu K, Or C, Chen J, Yan M, Wang H. An examination of the socio-demographic correlates of patient adherence to self-management behaviors and the mediating roles of health attitudes and self-efficacy among patients with coexisting type 2 diabetes and hypertension. BMC Public Health 2020; 20 (01) 1227
- 19 Whittle J, Yamal JM, Williamson JD. et al; ALLHAT Collaborative Research Group. Clinical and demographic correlates of medication and visit adherence in a large randomized controlled trial. BMC Health Serv Res 2016; 16: 236
- 20 Sandborn WJ, Tremaine WJ, Batts KP, Pemberton JH, Phillips SF. Pouchitis after ileal pouch-anal anastomosis: a Pouchitis Disease Activity Index. Mayo Clin Proc 1994; 69 (05) 409-415