A Digital Health Intervention to Improve the Clinical Care of Inflammatory Bowel Disease Patients

Abstract

Background: Inflammatory bowel disease (IBD) is a chronic condition that requires close monitoring. Digital health virtual care platforms can enable self-monitoring and allow providers to remotely surveil patients and efficiently identify those with active disease. Objective: The primary aim was to design and implement an IBD remote monitoring program, identify predictors of patient engagement, and determine who found the chat to be a valuable tool. Methods: We developed the IBD Virtual Care Chat, an electronic health record (EHR)-integrated chat to monitor electronic patient reported outcomes (ePROs), medication changes, and disease activity, and subsequently report concerning findings to providers via the EHR. All patients in the IBD practice over age 18 with a clinical encounter in the preceding 12 months were eligible to be enrolled. The primary aim was to identify predictors of patient engagement and determine who found the chat to be a valuable tool. Results: Between May 2021 and March 2022, 2,934 patients were enrolled. 1,160 engaged at least once and 687 (23.4%) continually engaged, submitting at least 3 ePROs. Disease severity (based on Harvey Bradshaw Index or Simple Clinical Colitis Activity Index) did not impact ePRO submissions. Patients were significantly more likely to be continually engaged if they self-reported the presence of extraintestinal manifestations (7%, 95%CI 0.01-0.14; p = 0.04). Patient satisfaction remained moderately high with a median score of 8 (IQR 5-10) on a scale of 1 (poor) to 10 (good). Conclusion: Our program demonstrates the potential for EHR integrated digital health as part of routine IBD care to achieve sustained engagement with high patient satisfaction.

Seamless Integration of Computer-Adaptive Patient Reported Outcomes into an Electronic Health Record

“…which, though low, is typical 30 . Within our clinics, medical assistants struggled to communicate the importance of PROs to patients 17 .…”

“… 16 26 27 Other research on electronic PRO implementation demonstrates a strong need to address patient engagement 28 29 —a challenge we faced as evidenced by our 25% patient PRO uptake rate which, though low, is typical. 30 Within our clinics, medical assistants struggled to communicate the importance of PROs to patients. 17 While strategies for obtaining patient buy-in is covered in previously cited materials, we note that including patient representatives in our design process may have improved the patient experience and thus patient buy-in.…”