Adapting, Scaling, and Spreading an Algorithmic Asthma Mobile Intervention to Promote Patient-Reported Outcomes Within Primary Care Settings

Asthma is a significant health issue in the Bronx, with mortality rates being the highest in the State of New York and hospitalization and emergency department visit rates triple the State average for all age groups. This is especially true for black and Hispanic individuals, who have higher rates of hospitalization for asthma than non-Hispanic whites. The high rates of asthma in the Bronx can be attributed to several factors, including poor access to healthcare, a lack of knowledge about proper medication use, and difficulty following medical regimens. These issues are compounded by the fact that the Bronx is one of the poorest urban counties in the United States.

To address these challenges, a mobile application (app) called ASTHMAXcel PRO was developed to facilitate self-management and shared decision making through patient-reported outcomes (PROs). The app was designed to be tailored to the needs of both healthcare providers (HCPs) and patients and optimized for use in primary care settings. The app is intended to be personalized, with a focus on sustained PRO collection and long-term use.

The specific aims were as follows:

• Adapt, test, and iteratively refine the ASTHMAXcel application for the primary care setting.
• Conduct a randomized controlled trial (RCT) to compare the adapted and refined ASTHMAXcel program to usual care.
• Evaluate the process of ASTHMAXcel implementation within the primary care setting.

In this study, researchers evaluated the effectiveness of the ASTHMAXcel PRO mobile intervention in an RCT to compare the app to the standard of care on process outcomes, asthma knowledge, PROs, and clinical outcomes. The app was available on iOS and Android and included nine chapters of guidelines-based asthma education. The app included 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. The researchers found that the app resulted in significant improvements in asthma quality of life, control, and knowledge, as well as decreased healthcare utilization.

Researchers found that the app was acceptable to both adult asthma patients and HCPs in the primary care setting, with a high degree of user acceptance and satisfaction. The app has since been extended to nine additional patient-facing mobile applications for other medical conditions, and the researchers have raised scientific awareness about the development and validation of mobile interventions through presentations and publications. This study offers important lessons about the implementation of virtual cohort studies and the importance of involving both patients and HCPs in the development and implementation of mobile interventions.