Background
Ascertainment of hospitalizations is critical to assess quality of care and the effectiveness and adverse effects of various therapies. Smartphones, mobile geo-locators that are ubiquitous, have not been leveraged to ascertain hospitalizations. Therefore, we evaluated the use of smartphone-based “geofencing” to track hospitalizations.
Methods and Results
Participants ages ≥ 18 years installed a mobile application programmed to “geofence” all hospitals using global positioning systems and cell phone tower triangulation and to trigger a smartphone-based questionnaire when located in a hospital for ≥ 4 hours. An “in-person” study included consecutive consenting patients scheduled for electrophysiology and cardiac catheterization procedures. A “remote” arm invited Health eHeart Study participants that consented and engaged with the study via the internet only. The accuracy of application-detected hospitalizations was confirmed by medical record review as the reference standard. Of 22 eligible “in-person” patients, 17 hospitalizations were detected (sensitivity 77%; 95% confidence interval [CI] 55-92%). The length of stay according to the application was positively correlated with the length of stay ascertained via the electronic medical record (r=0.53, p=0.03). In the remote arm, the application was downloaded by 3,443 participants residing in all 50 U.S. states; 243 hospital visits at 119 different hospitals were detected through the application. The positive predictive value for an application-reported hospitalization was 65% (95% CI 57-72%).
Conclusions
Mobile application-based ascertainment of hospitalizations can be achieved with modest accuracy. This first proof of concept may ultimately be applicable to “geofencing” other types of prespecified locations to facilitate healthcare research and patient care.
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