ASTHMAXcel PRO Mobile Application to Support Asthma Chronic Disease Management

Many factors contribute to poor health outcomes for people with asthma

Mortality rates related to asthma for Bronx residents are the highest in New York State, with Black and Hispanic people disproportionally affected. Many factors contribute to the high asthma burden in the Bronx, including poverty, environmental triggers, suboptimal access to healthcare, lack of patient knowledge regarding proper medication use, and difficulty adhering to medical regimens.

Primary care providers who use evidence-based asthma guidelines and provide asthma education to patients are critical to achieving asthma control. However, during time-constrained visits, providers often have limited time to discuss asthma symptoms or triggers and to provide asthma education.

Use of patient-reported outcomes will improve patient self-management and shared decision making between patients and providers

Dr. Sunit Jariwala, a practicing allergy immunology clinician and board certified clinical informaticist, together with a team of researchers from the Albert Einstein College of Medicine, set out to find a solution to better deliver evidence-based care and patient education to people with asthma, including providing guidance and support between clinic visits. The team developed the ASTHMAXcel PRO mobile application, which facilitates the collection and use of patient-reported outcomes (PROs), to improve self-management and shared decision making so that patients can achieve optimal asthma control. Collecting PRO measures is at the core of ASTHMAXcel PRO and is crucial to the app’s adaptive and personalized nature.

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The research team involved patients, their families, and clinicians in the iterative development of the app, which is tailored to the needs of clinicians and patients and is optimized for use in primary care settings. To best facilitate the submission of PROs, the research team included specific platform features requested by patients. For example, the app has virtual coins, virtual trophies, and virtual leaderboards that patients suggested would incentivize them to use the app. The app, available on both iOS and Android, also includes nine chapters of guidelines-based asthma education. And to engage patients, the app offers push notifications for daily medication reminders, weekly messages of encouragement and behavioral support, and monthly check-ins on recent asthma-related hospital visits and steroid courses. This research shows the power of user-centered design: these features that the patients initially suggested were most indicative of their engagement once the app rolled out.

"We saw the positive impact [of the tool] on asthma control and asthma quality of life, as well as trends of decreased Emergency Department visits, hospitalizations, and steroid courses for the patients.”- Dr. Sunit P. Jariwala

App improves patient care and has been successfully adapted for other conditions

Dr. Jariwala and team evaluated the ASTHMAXcel PRO mobile intervention in a randomized controlled trial and found that the use of the app significantly improved asthma quality of life, control, and knowledge, as well as decreased healthcare utilization. The app has since been extended to nine additional medical conditions, showing the value of mobile apps and participatory design for PROs collection and use to improve patient self-management and health outcomes. In addition, the team recently was awarded a followup grant from AHRQ to adapt the ASTHMAXcel platform to incorporate voice samples and social determinants of health data with the goal to favorably impact asthma control.