Study: Patient engagement, clinical support platform improves IBD quality of care

By Dave Muoio
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A software platform developed at Mount Sinai comprising of a mobile app for patients and a decision support dashboard for practitioners can improve inflammatory bowel disease (IBD) patients’ quality of care, according to clinical data recently presented at the Advances in Inflammatory Bowel Diseases Conference.

By implementing tools that allow care teams to monitor symptoms and more conveniently communicate with their patients, the HealthPROMISE platform improved patients' health outcomes and long-term engagement, Dr. Ashish Atreja, chief innovation and engagement officer at Mount Sinai, and colleagues reported.

“Patients were coming to see us once or twice a year, but a lot of times we were finding patients falling through the cracks [and] there were symptoms they had for many months before they came back to us,” Atreja told MobiHealthNews. “Three or four hours of physician-time a year is not relevant for many of the patients. We need to have a way to proactively assess how they’re doing every single week or every single month … that’s why we [Sinai AppLab] built this monitoring toolkit called HealthPROMISE.”

Through HealthPROMISE’s app, patients are able to update their information while receiving a summary of various quality of care metrics as well as quality of life trends specific to IBD. They also receive the support of a population health coordinator, who monitors patient data through the HealthPROMISE dashboard and communicates with patients and their care teams as needed. In addition, Atreja explained, the platform can also assist with the collection of symptom, adherence, and other data that can be incorporated into future care strategies.

To test the system, Atreja and colleagues conducted a two-year, National Institutes of Health-sponsored trial enrolling 320 IBD patients. Of these, 158 were randomly assigned to receive a basic educational app while 162 were provided the full HealthPROMISE intervention. The researchers’ primary endpoint was changes in quality of care metrics, with secondary endpoints relating to decreases in IBD-related emergency visits and hospitalizations, shifts in quality of life scores, and the proportion of patients who reported controlled disease status within each study group.

At 575 days follow-up, Atreja and colleagues found a significant improvement in IBD-specific quality of life among patients who received the intervention, and noted that uncontrolled anxiety and fatigue were the primary drivers of poor quality of life. Quality of care improved among all of the study’s participants at first follow-up, but increased more significantly among those who received HealthPROMISE. This trend followed at the patients’ second follow-up, with an even more substantial increase among the intervention group. In addition, app usage data data showed that roughly 75 percent of HealthPROMISE recipients continued to log in to the app throughout the study to update their symptoms and information.

“We are finding just spectacular results of patients continuing to engage, even at the end of two years,” Atreja said.

This particular result is an extremely important component of ensuring high quality of care, Atreja continued, and is the primary benefit of a platform designed to improve long-term patient-provider communications.

“The patients feel that they have a relationship with their physicians that is ongoing, and not ending just at the office visit,” he said. “They hear from their care team more than two or three times a year, and that, we found, is the biggest factor for continued engagement. If it was just an app that tracked your symptoms but they don’t hear back from their physician, they would directly lose value in that app.”