Project Details -

Ongoing

Poor outcomes for minority patients with asthma have been linked to poverty and other social determinants of health (SDOH), environmental exposures, and poor self-management. In a previous AHRQ-funded study, the researchers developed and pilot tested ASTHMAXcel PRO, a mobile app that promotes self-management of asthma. The app was optimized for outpatient settings and promotes asthma self-management through the collection of patient-reported outcomes (PROs), animated videos, goal setting, personalized algorithms, and push notifications. The use of the app led to significant decreases in the need for steroids, visits for asthma to the emergency department, and hospitalizations for asthma.

In this current research, ASTHMAXcel PRO will be enhanced to create ASTHMAXcel Voice, an app that will use voice biomarkers to detect worsening symptoms. This technology uses machine learning to assess respiratory dysfunction, including asthma, based on a 6-second voice sample. From the sample, a Respiratory Symptoms Risk Score (RSRS) is calculated that correlates with the speaker’s risk of respiratory impairment: a 10 percent increase in the score is associated with declines in asthma control. The updated platform will calculate the patient’s RSRS; facilitate shared decision making, screen for SDOH, and referrals; improve the ability of patients to self-manage; and allow for remote care coordination.

The specific aims of the research are as follows:

To adapt, test, and refine ASTHMAXcel Voice for the outpatient setting.
To conduct a randomized controlled trial (RCT) to compare the adapted and refined ASTHMAXcel Voice platform to usual care.
To evaluate the process of ASTHMAXcel Voice implementation within the outpatient setting.

Using input from focus groups with patients, healthcare providers, social workers, community health workers, and expert stakeholders, ASTHMAXcel PRO will be adapted to include voice biomarkers, becoming ASTHMAXcel Voice. The research team will conduct formative and summative evaluations of functionality and usability. Following this, an RCT will be conducted with outpatient primary and specialty care sites comparing the use of ASTHMAXcel Voice to usual care on clinical and process outcomes, SDoH screening and referral rates, quality of life, medication adherence, and self-efficacy. The process of implementation of the platform in the outpatient setting will also be evaluated. The researchers plan to enhance the platform for other chronic diseases in the future.

ASTHMAXcel Voice Mobile Application to Improve Chronic Disease Management and Patient Outcomes

Theme:

Engaging and Empowering Patients

Subtheme:

Using Patient-Reported Outcomes for Chronic Disease Management

A mobile app that uses voice biomarkers to assess asthma symptoms has the potential to improve self-management, shared decision making, and health outcomes for people with asthma.

Many factors contribute to poor health outcomes for people with asthma

Asthma rates 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 area, including social determinants of health (SDOH), environmental exposures, and poor self-management.

In a previous AHRQ-funded study, Drs. Sunit Jariwala—a practicing allergy immunology clinician—and Jonathan Feldman—a clinical psychologist—and a team of researchers from the Albert Einstein College of Medicine developed and pilot tested ASTHMAXcel PRO. The mobile app promotes self-management of asthma through the collection of patient-reported outcomes, goal setting, personalized algorithms, and push notifications. Findings showed that patients who used the app had better asthma outcomes, including decreased use of steroids, as well as fewer visits to the emergency department (ED) and hospitalizations.

Use of voice biomarkers may help people identify and address asthma symptoms

Following the successful results of ASTHMAXcel PRO, Drs. Jariwala and Feldman wondered if they could leverage the success of the app to facilitate screening on the types of SDOH their patients experience. SDOH are the nonmedical factors that influence health outcomes. Poor SDOH can include food insecurity, housing concerns, or transportation to medical appointments, and can all have a negative impact on chronic disease management. By building SDOH screening into the app, patients will be contacted by social workers or community health workers to get the proper referrals to the support services they need, promoting a multidisciplinary team-based approach for comprehensive asthma care. The app will also have tailored push notifications to assess and remind patients to follow through on these referrals.

Another update to the tool will be integration of voice biomarkers. The voice biomarker technology uses machine learning to assess respiratory dysfunction, including asthma, based on a 6-second voice sample. From the voice sample that patients record on their phones, a respiratory symptoms risk score is calculated to signify the patient’s risk of respiratory impairment. The score will trigger an alert to patients when their asthma symptoms may be worsening and provide just-in-time adaptive interventions—action steps to address and improve their symptoms.

As Dr. Feldman noted, “A lot of patients can underperceive their asthma symptoms and miss those times when their asthma is flaring up. This is a very simple tool that can help increase patients’ awareness and improve self-management when their asthma is getting worse.”

A multidisciplinary approach may improve chronic disease management

The updates to the tool, now called ASTHMAXcel Voice, will be informed by input from patients, healthcare providers, social workers, and community health workers. The team will study the app’s impact on asthma control, ED visits, SDOH screening and referral rates, and medication adherence. If successful, the team will enhance the platform to support other chronic diseases in the future.

“The use of the voice biomarker makes this research novel and innovative. A 6-second voice recording may help prompt a patient during the earlier stages of an asthma exacerbation to act on it and prevent it from becoming a full-blown asthma flare and ending up in the ER, needing oral steroids, or even worse.” – Dr. Jonathan Feldman