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Appl Clin Inform 2024; 15(04): 785-797
DOI: 10.1055/s-0044-1788978
Research Article

Evaluation of a Primary Care-Integrated Mobile Health Intervention to Monitor between-Visit Asthma Symptoms

Jorge A. Sulca Flores
1   Division of General Internal Medicine Primary Care, Brigham and Women's Hospital, Boston, Massachusetts, United States
,
Anuj K. Dalal
1   Division of General Internal Medicine Primary Care, Brigham and Women's Hospital, Boston, Massachusetts, United States
2   Harvard Medical School, Boston, Massachusetts, United States
,
Jessica Sousa
3   Health Care Division, RAND, Boston, Massachusetts, United States
,
Dinah Foer
2   Harvard Medical School, Boston, Massachusetts, United States
4   Division of Allergy and Clinical Immunology, Brigham and Women's Hospital, Boston, Massachusetts, United States
,
Jorge A. Rodriguez
1   Division of General Internal Medicine Primary Care, Brigham and Women's Hospital, Boston, Massachusetts, United States
2   Harvard Medical School, Boston, Massachusetts, United States
,
Savanna Plombon
1   Division of General Internal Medicine Primary Care, Brigham and Women's Hospital, Boston, Massachusetts, United States
,
David W. Bates
1   Division of General Internal Medicine Primary Care, Brigham and Women's Hospital, Boston, Massachusetts, United States
2   Harvard Medical School, Boston, Massachusetts, United States
,
Adriana Arcia
5   Hahn School of Nursing and Health Science, University of San Diego, San Diego, California, United States
,
Robert S. Rudin
3   Health Care Division, RAND, Boston, Massachusetts, United States
› Author Affiliations Funding This project was supported by grant numbers R18HS026432 and R18HS026432-02S1 from the Agency for Healthcare Research and Quality. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health or the Agency for Healthcare Research and Quality.
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Abstract

Objectives This study aimed to evaluate implementation of a digital remote symptom monitoring intervention that delivered weekly symptom questionnaires and included the option to receive nurse callbacks via a mobile app for asthma patients in primary care.

Methods Research questions were structured by the NASSS (Nonadoption, Abandonment, Scale-up Spread, and Sustainability) framework. Quantitative and qualitative methods assessed scalability of the electronic health record (EHR)-integrated app intervention implemented in a 12-month randomized controlled trial. Data sources included patient asthma control questionnaires; app usage logs; EHRs; and interviews and discussions with patients, primary care providers (PCPs), and nurses.

Results We included app usage data from 190 patients and interview data from 21 patients and several clinician participants. Among 190 patients, average questionnaire completion rate was 72.3% and retention was 78.9% (i.e., 150 patients continued to use the app at the end of the trial period). App use was lower among Hispanic and younger patients and those with fewer years of education. Of 1,185 nurse callback requests offered to patients, 33 (2.8%) were requested. Of 84 PCP participants, 14 (16.7%) accessed the patient-reported data in the EHR. Analyses showed that the intervention was appropriate for all levels of asthma control; had no major technical barriers; was desirable and useful for patient treatment; involved achievable tasks for patients; required modest role changes for clinicians; and was a minimal burden on the organization.

Conclusion A clinically integrated symptom monitoring intervention has strong potential for sustained adoption. Inequitable adoption remains a concern. PCP use of patient-reported data during visits could improve intervention adoption but may not be required for patient benefits.

Keywords

remote symptom monitoring - electronic health record integration - user-centered design - intervention design - mobile health - digital health implementation - asthma

Protection of Human and Animal Subjects

This study was approved by the Mass General Brigham and RAND Institutional Review Boards.


Note

Preliminary results were presented at the American Medical Informatics Annual Symposium, November 2023, New Orleans, Louisiana, United States.


Supplementary Material



Publication History

Received: 22 April 2024

Accepted: 17 July 2024

Article published online:
02 October 2024

© 2024. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

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