Download PDF
Appl Clin Inform 2019; 10(05): 783-793
DOI: 10.1055/s-0039-1697597
Research Article
Georg Thieme Verlag KG Stuttgart · New York

A Clinically Integrated mHealth App and Practice Model for Collecting Patient-Reported Outcomes between Visits for Asthma Patients: Implementation and Feasibility

Robert S. Rudin
1   RAND Corporation, Boston, Massachusetts, United States
,
Christopher H. Fanta
2   Partners Asthma Center, Brigham and Women’s Hospital, Boston, Massachusetts, United States
,
Nabeel Qureshi
3   RAND Corporation, Santa Monica, California, United States
,
Erin Duffy
3   RAND Corporation, Santa Monica, California, United States
,
Maria O. Edelen
1   RAND Corporation, Boston, Massachusetts, United States
,
Anuj K. Dalal
4   Division of General Internal Medicine, Brigham and Women's Hospital, Boston, Massachusetts, United States
,
David W. Bates
5   Division of General Internal Medicine, Department of Health Policy and Management, Brigham and Women's Hospital, Harvard Chan School of Public Health, Boston, Massachusetts, United States
› Author Affiliations Funding This work was supported by the Agency for Healthcare Research and Quality grant #1R21HS023960.
Further Information

Publication History

03 June 2019

07 August 2019

Publication Date:
16 October 2019 (online)

   Permissions and Reprints

Abstract

Objective Mobile health (mHealth) apps may prove to be useful tools for supporting chronic disease management. We assessed the feasibility of implementing a clinically integrated mHealth app and practice model to facilitate between-visit asthma symptom monitoring as per guidelines and with the help of patient-reported outcomes (PRO).

Methods We implemented the intervention at two pulmonary clinics and conducted a mixed-methods analysis of app usage data and semi-structured interview of patients and clinician participants over a 25-week study period.

Results Five physicians, 1 physician's assistant, 1 nurse, and 26 patients participated. Twenty-four patients (92%) were still participating in the intervention at the end of the 25-week study period. On average, each patient participant completed 21 of 25 questionnaires (84% completion rate). Weekly completion rates were higher for participants who were female (88 vs. 73%, p = 0.02) and obtained a bachelor's degree level or higher (94 vs. 74%, p = 0.04). On average, of all questionnaires, including both completed and not completed (25 weekly questionnaires times 26 patient participants), 25% had results severe enough to qualify for a callback from a nurse; however, patients declined this option in roughly half of the cases in which they were offered the option. We identified 6 key themes from an analysis of 21 patients and 5 clinician interviews. From the patient's perspective, these include more awareness of asthma, more connected with provider, and app simplicity. From the clinician's perspective, these include minimal additional work required, facilitating triage, and informing conversations during visits.

Conclusion Implementation of a clinically integrated mHealth app and practice model can achieve high patient retention and adherence to guideline-recommended asthma symptom monitoring, while minimally burdening clinicians. The intervention has the potential for scaling to primary care and reducing utilization of urgent and emergency care.

Keywords

mHealth - patient-reported outcomes - asthma - telehealth - feasibility study

Protection of Human and Animal Subjects

This study was approved by RAND and Partners Healthcare Institutional Review Board.


Supplementary Material

 

  • References

  • 1 Han M, Lee E. Effectiveness of mobile health application use to improve health behavior changes: a systematic review of randomized controlled trials. Healthc Inform Res 2018; 24 (03) 207-226
    CrossrefPubMedGoogle Scholar
  • 2 Singh K, Drouin K, Newmark LP. , et al. Many mobile health apps target high-need, high-cost populations, but gaps remain. Health Aff (Millwood) 2016; 35 (12) 2310-2318
    CrossrefPubMedGoogle Scholar
  • 3 Smith A. Record shares of Americans now own smartphones, have home broadband. 2017 . Available at: http://www.pewresearch.org/fact-tank/2017/01/12/evolution-of-technology/# . Accessed January 12, 2017
    PubMedGoogle Scholar
  • 4 Pew Research Center. Mobile fact sheet. Available at: http://www.pewinternet.org/fact-sheet/mobile/ . Published 2018. Accessed July 12, 2019
    PubMedGoogle Scholar
  • 5 Rhoades H, Wenzel S, Rice E, Winetrobe H, Henwood B. No digital divide? Technology use among homeless adults. J Soc Distress Homeless 2017; 26 (01) 73-77
    CrossrefPubMedGoogle Scholar
  • 6 Tinschert P, Jakob R, Barata F, Kramer JN, Kowatsch T. The potential of mobile apps for improving asthma self-management: a review of publicly available and well-adopted asthma apps. JMIR Mhealth Uhealth 2017; 5 (08) e113
    CrossrefPubMedGoogle Scholar
  • 7 Hui CY, Walton R, McKinstry B, Pinnock H. Time to change the paradigm? A mixed method study of the preferred and potential features of an asthma self-management app. Health Informatics J 2019 . Doi: 10.1177/1460458219853381
    PubMedGoogle Scholar
  • 8 Ramsey RR, Caromody JK, Voorhees SE. , et al. A systematic evaluation of asthma management apps examining behavior change techniques. J Allergy Clin Immunol Pract 2019 . Doi: 10.1016/j.jaip.2019.03.041
    PubMedGoogle Scholar
  • 9 Hui CY, McKinstry B, Walton R, Pinnock H. A mixed method observational study of strategies to promote adoption and usage of an application to support asthma self-management. J Innov Health Inform 2019; 25 (04) 243-253
    PubMedGoogle Scholar
  • 10 Laing BY, Mangione CM, Tseng CH. , et al. Effectiveness of a smartphone application for weight loss compared with usual care in overweight primary care patients: a randomized, controlled trial. Ann Intern Med 2014; 161 (10, Suppl): S5-S12
    CrossrefPubMedGoogle Scholar
  • 11 Black N. Patient reported outcome measures could help transform healthcare. BMJ 2013; 346: f167
    CrossrefPubMedGoogle Scholar
  • 12 Basch E, Deal AM, Kris MG. , et al. Symptom monitoring with patient-reported outcomes during routine cancer treatment: a randomized controlled trial. J Clin Oncol 2016; 34 (06) 557-565
    PubMedGoogle Scholar
  • 13 Howell D, Molloy S, Wilkinson K. , et al. Patient-reported outcomes in routine cancer clinical practice: a scoping review of use, impact on health outcomes, and implementation factors. Ann Oncol 2015; 26 (09) 1846-1858
    CrossrefPubMedGoogle Scholar
  • 14 Zhang R, Burgess ER, Reddy MC. , et al. Provider perspectives on the integration of patient-reported outcomes in an electronic health record. JAMIA Open 2019; 2 (01) 73-80
    CrossrefPubMedGoogle Scholar
  • 15 Centers for Disease Control and Prevention. Asthma in the US. CDC vital signs, May website. Available at: http://www.cdc.gov/vitalsigns/asthma . Published 2011. Accessed August 30, 2019
    PubMedGoogle Scholar
  • 16 World Health Organization. Asthma fact sheet No. 307. Updated November 2013. Available at: http://www.who.int/topics/asthma/en . Published 2008. Accessed August 30, 2019
    PubMed
  • 17 Wang T, Srebotnjak T, Brownell J, Hsia RY. Emergency department charges for asthma-related outpatient visits by insurance status. J Health Care Poor Underserved 2014; 25 (01) 396-405
    CrossrefPubMedGoogle Scholar
  • 18 Okelo SO, Butz AM, Sharma R. , et al. Interventions to modify health care provider adherence to asthma guidelines: a systematic review. Pediatrics 2013; 132 (03) 517-534
    CrossrefPubMedGoogle Scholar
  • 19 Wisnivesky JP, Lorenzo J, Lyn-Cook R. , et al. Barriers to adherence to asthma management guidelines among inner-city primary care providers. Ann Allergy Asthma Immunol 2008; 101 (03) 264-270
    CrossrefPubMedGoogle Scholar
  • 20 Marcano Belisario JS, Huckvale K, Greenfield G, Car J, Gunn LH. Smartphone and tablet self management apps for asthma. Cochrane Database Syst Rev 2013; (11) CD010013
    PubMedGoogle Scholar
  • 21 Hui CY, Walton R, McKinstry B, Jackson T, Parker R, Pinnock H. The use of mobile applications to support self-management for people with asthma: a systematic review of controlled studies to identify features associated with clinical effectiveness and adherence. J Am Med Inform Assoc 2017; 24 (03) 619-632
    CrossrefPubMedGoogle Scholar
  • 22 Wiecha JM, Adams WG, Rybin D, Rizzodepaoli M, Keller J, Clay JM. Evaluation of a web-based asthma self-management system: a randomised controlled pilot trial. BMC Pulm Med 2015; 15 (01) 17
    CrossrefPubMedGoogle Scholar
  • 23 Vasbinder EC, Janssens HM, Rutten-van Mölken MPMH. , et al; e-MATIC Study Group. e-Monitoring of asthma therapy to improve compliance in children using a real-time medication monitoring system (RTMM): the e-MATIC study protocol. BMC Med Inform Decis Mak 2013; 13 (01) 38
    CrossrefPubMedGoogle Scholar
  • 24 Rasmussen LM, Phanareth K, Nolte H, Backer V. Internet-based monitoring of asthma: a long-term, randomized clinical study of 300 asthmatic subjects. J Allergy Clin Immunol 2005; 115 (06) 1137-1142
    CrossrefPubMedGoogle Scholar
  • 25 Wu AC, Carpenter JF, Himes BE. Mobile health applications for asthma. J Allergy Clin Immunol Pract 2015; 3 (03) 446-8.e1 , 16
    CrossrefPubMedGoogle Scholar
  • 26 Kew KM, Cates CJ. Home telemonitoring and remote feedback between clinic visits for asthma. Cochrane Database Syst Rev 2016; (08) CD011714
    PubMedGoogle Scholar
  • 27 Stukus DR, Farooqui N, Strothman K. , et al. Real-world evaluation of a mobile health application in children with asthma. Ann Allergy Asthma Immunol 2018; 120 (04) 395-400
    CrossrefPubMedGoogle Scholar
  • 28 Farzandipour M, Nabovati E, Sharif R, Arani MH, Anvari S. Patient self-management of asthma using mobile health applications: a systematic review of the functionalities and effects. Appl Clin Inform 2017; 8 (04) 1068-1081
    Article in Thieme ConnectPubMedGoogle Scholar
  • 29 Merchant R, Inamdar R, Henderson K. , et al. Digital health intervention for asthma: patient-reported value and usability. JMIR Mhealth Uhealth 2018; 6 (06) e133
    CrossrefPubMedGoogle Scholar
  • 30 van Gaalen JL, van Bodegom-Vos L, Bakker MJ, Snoeck-Stroband JB, Sont JK. Internet-based self-management support for adults with asthma: a qualitative study among patients, general practitioners and practice nurses on barriers to implementation. BMJ Open 2016; 6 (08) e010809
    CrossrefPubMedGoogle Scholar
  • 31 Rudin RS, Fanta CH, Predmore Z. , et al. Core components for a clinically integrated mhealth app for asthma symptom monitoring. Appl Clin Inform 2017; 8 (04) 1031-1043
    Article in Thieme ConnectPubMedGoogle Scholar
  • 32 Greenhalgh T, Wherton J, Papoutsi C. , et al. Beyond adoption: a new framework for theorizing and evaluating nonadoption, abandonment, and challenges to the scale-up, spread, and sustainability of health and care technologies. J Med Internet Res 2017; 19 (11) e367
    CrossrefPubMedGoogle Scholar
  • 33 Lancaster GA, Dodd S, Williamson PR. Design and analysis of pilot studies: recommendations for good practice. J Eval Clin Pract 2004; 10 (02) 307-312
    CrossrefPubMedGoogle Scholar
  • 34 Palinkas LA, Horwitz SM, Green CA, Wisdom JP, Duan N, Hoagwood K. Purposeful sampling for qualitative data collection and analysis in mixed method implementation research. Adm Policy Ment Health 2015; 42 (05) 533-544
    CrossrefPubMedGoogle Scholar
  • 35 Hooper R. Justifying Sample Size for a Feasibility Study. London, England: National Institute for Health Research; 2019
    Google Scholar
  • 36 Lang DM. New asthma guidelines emphasize control, regular monitoring. Cleve Clin J Med 2008; 75 (09) 641-653
    CrossrefPubMedGoogle Scholar
  • 37 van der Meer V, van Stel HF, Bakker MJ. , et al; SMASHING (Self-Management of Asthma Supported by Hospitals, ICT, Nurses and General practitioners) Study Group. Weekly self-monitoring and treatment adjustment benefit patients with partly controlled and uncontrolled asthma: an analysis of the SMASHING study. Respir Res 2010; 11 (01) 74
    CrossrefPubMedGoogle Scholar
  • 38 Lara M, Edelen MO, Eberhart NK, Stucky BD, Sherbourne CD. Development and validation of the RAND asthma control measure. Eur Respir J 2014; 44 (05) 1243-1252
    CrossrefPubMedGoogle Scholar
  • 39 Schatz M, Sorkness CA, Li JT. , et al. Asthma control test: reliability, validity, and responsiveness in patients not previously followed by asthma specialists. J Allergy Clin Immunol 2006; 117 (03) 549-556
    CrossrefPubMedGoogle Scholar
  • 40 Creswell JW, Clark VLP. Designing and Conducting Mixed Methods Research. 2nd ed. Los Angeles: SAGE Publications, Inc.; 2010
    Google Scholar
  • 41 Johnson KM, FitzGerald JM, Tavakoli H, Chen W, Sadatsafavi M. Stability of asthma symptom control in a longitudinal study of mild-moderate asthmatics. J Allergy Clin Immunol Pract 2017; 5 (06) 1663.e5-1670.e5
    PubMedGoogle Scholar
  • 42 Bernard HR, Ryan GW. Analyzing Qualitative Data: Systematic Approaches. Thousand Oaks, CA, US: Sage Publications, Inc; 2010
    Google Scholar
  • 43 Saunders B, Sim J, Kingstone T. , et al. Saturation in qualitative research: exploring its conceptualization and operationalization. Qual Quant 2018; 52 (04) 1893-1907
    CrossrefPubMedGoogle Scholar
  • 44 Pignataro FS, Bonini M, Forgione A, Melandri S, Usmani OS. Asthma and gender: The female lung. Pharmacol Res 2017; 119: 384-390
    CrossrefPubMedGoogle Scholar
  • 45 Mathes T, Jaschinski T, Pieper D. Adherence influencing factors - a systematic review of systematic reviews. Arch Public Health 2014; 72 (01) 37
    CrossrefPubMedGoogle Scholar
  • 46 Simpson AJ, Honkoop PJ, Kennington E. , et al. Perspectives of patients and healthcare professionals on mHealth for asthma self-management. Eur Respir J 2017; 49 (05) 1601966
    CrossrefPubMedGoogle Scholar
  • 47 Morita PP, Yeung MS, Ferrone M. , et al. A Patient-centered mobile health system that supports asthma self-management (breathe): design, development, and utilization. JMIR Mhealth Uhealth 2019; 7 (01) e10956
    CrossrefPubMedGoogle Scholar
  • 48 Pernell BM, DeBaun MR, Becker K, Rodeghier M, Bryant V, Cronin RM. Improving medication adherence with two-way short message service reminders in sickle cell disease and asthma. a feasibility randomized controlled trial. Appl Clin Inform 2017; 8 (02) 541-559
    Article in Thieme ConnectPubMedGoogle Scholar
  • 49 Han Y, Faulkner MS, Fritz H. , et al. A pilot randomized trial of text-messaging for symptom awareness and diabetes knowledge in adolescents with Type 1 diabetes. J Pediatr Nurs 2015; 30 (06) 850-861
    CrossrefPubMedGoogle Scholar
  • 50 Agyapong VIO, Juhás M, Ohinmaa A. , et al. Randomized controlled pilot trial of supportive text messages for patients with depression. BMC Psychiatry 2017; 17 (01) 286-286
    CrossrefPubMedGoogle Scholar
  • 51 Groat D, Soni H, Grando MA, Thompson B, Kaufman D, Cook CB. Design and testing of a smartphone application for real-time self-tracking diabetes self-management behaviors. Appl Clin Inform 2018; 9 (02) 440-449
    Article in Thieme ConnectPubMedGoogle Scholar
  • 52 Datillo JR, Gittings DJ, Sloan M, Hardaker WM, Deasey MJ, Sheth NP. “Is there an app for that?” orthopaedic patient preferences for a smartphone application. Appl Clin Inform 2017; 8 (03) 832-844
    Article in Thieme ConnectPubMedGoogle Scholar
  • 53 Carrera A, Pifarré M, Vilaplana J. , et al. BPcontrol. A mobile app to monitor hypertensive patients. Appl Clin Inform 2016; 7 (04) 1120-1134
    Article in Thieme ConnectPubMedGoogle Scholar