Project Details - Ended
- Grant Number:R21 HS023960
- Funding Mechanism:
- AHRQ Funded Amount:$298,972
- Principal Investigator:
- Project Dates:5/1/2015 to 4/30/2018
- Medical Condition:
- Health Care Theme:
Asthma affects more than 25 million individuals in the United States, and can lead to morbidity, disruption in lives, hospitalizations, and early deaths. Recent updates to existing guidelines call for providers to adjust treatment based on serial monitoring of patients’ symptoms. Mobile health (mHealth) and smartphone technology can allow patients to report symptoms more frequently and conveniently outside of an office visit, and make those data available to providers. While more than three-quarters of Americans currently own smartphones, mHealth solutions are not widely used to facilitate collection of asthma-related patient-reported outcomes (PROs) for routine use in clinical care.
This research designed an application (app) and practice model for asthma patients using user-centered design principles. The practice model included three components for patients: 1) invitations to participate by their physicians; 2) weekly questionnaires and periodic calls from a nurse; and 3) the ability to view their data graphically. A fourth component of the practice model allowed physicians to access patients’ data from within their electronic health records. The goals of the research were that patients with asthma would complete a questionnaire about their symptoms on a weekly basis; and that providers would find the app clinically beneficial and not burdensome to use. Researchers conducted a 6-month feasibility test in two subspecialty care clinics, and evaluated results through analysis of app usage logs and semi-structured interview data.
The specific aims of the research were as follows:
- Assess the extent to which patients use the app, and better understand the factors that influence their usage.
- Understand the benefits and barriers to integrating the practice model into clinical care from the clinician’s perspective.
- Identify opportunities for enhancements to the app and practice model.
At the end of 6 months, 92 percent of patients were still completing weekly PRO questionnaires, with female and more educated participants having higher rates of completion. Of all questionnaire responses, nearly a quarter qualified for a possible call from a nurse, with over 80 percent receiving at least one call. Interviews with 21 patients suggested that the app was simple and easy to use, increased awareness of their asthma symptoms and “flares,” made them feel more connected to their provider, and avoided emergency care. Providers reported minimal workflow burden. Patients and providers suggested many enhancements, including recording peak flows and details on recent symptoms and treatment.
The researchers found that a simple mHealth app for asthma symptom monitoring can achieve high patient engagement when integrated into clinical care, and identified that enhancements to the intervention would likely be needed to modify for use in primary care. This work may serve as a model for developing mHealth tools and practice models for other chronic conditions.