Impact of the Mobile HealthPROMISE Platform on the Quality of Care and Quality of Life in Patients With Inflammatory Bowel Disease: Study Protocol of a Pragmatic Randomized Controlled Trial

Abstract

BackgroundInflammatory bowel disease (IBD) is a chronic condition of the bowel that affects over 1 million people in the United States. The recurring nature of disease makes IBD patients ideal candidates for patient-engaged care that is centered on enhanced self-management and improved doctor-patient communication. In IBD, optimal approaches to management vary for patients with different phenotypes and extent of disease and past surgical history. Hence, a single quality metric cannot define a heterogeneous disease such as IBD, unlike hypertension and diabetes. A more comprehensive assessment may be provided by complementing traditional quality metrics with measures of the patient’s quality of life (QOL) through an application like HealthPROMISE.ObjectiveThe objective of this pragmatic randomized controlled trial is to determine the impact of the HealthPROMISE app in improving outcomes (quality of care [QOC], QOL, patient adherence, disease control, and resource utilization) as compared to a patient education app. Our hypothesis is that a patient-centric self-monitoring and collaborative decision support platform will lead to sustainable improvement in overall QOL for IBD patients.MethodsParticipants will be recruited during face-to-face visits and randomized to either an interventional (ie, HealthPROMISE) or control (ie, education app). Patients in the HealthPROMISE arm will be able to update their information and receive disease summary, quality metrics, and a graph showing the trend of QOL (SIBDQ) scores and resource utilization over time. Providers will use the data for collaborative decision making and quality improvement interventions at the point of care. Patients in the control arm will enter data at baseline, during office visits, and at the end of the study but will not receive any decision support (trend of QOL, alert, or dashboard views).ResultsEnrollment in the trial will be starting in first quarter of 2015. It is intended that up to 300 patients with IBD will be recruited into the study (with 1:1 allocation ratio). The primary endpoint is number of quality indicators met in HealthPROMISE versus control arm. Secondary endpoints include decrease in number of emergency visits due to IBD, decrease in number of hospitalization due to IBD, change in generic QOL score from baseline, proportion of patients in each group who meet all eligible outpatient quality metrics, and proportion of patients in disease control in each group. In addition, we plan to conduct protocol analysis of intervention patients with adequate HealthPROMISE utilization (more than 6 log-ins with data entry from week 0 through week 52) achieving above mentioned primary and secondary endpoints.ConclusionsHealthPROMISE is a unique cloud-based patient-reported outcome (PRO) and decision support tool that empowers both patients and providers. Patients track their QOL and symptoms, and providers can use the visual data in real time (integrated with electronic health records [EHRs]) to provide better care to their entire patient population. U...

White Paper AGA: The Impact of Mental and Psychosocial Factors on the Care of Patients With Inflammatory Bowel Disease

“…75 The survey tools presented above are being adapted into brief patient-reported instruments that take less than a minute for patients to complete. Some can be completed remotely 76 or via tablets or kiosks in offices that directly link the information to the electronic health record. If time or resources are limited, health-related quality of life instruments can serve as brief surveys of sleep, fatigue, pain, tension, depression, and other psychosocial domains.…”

“…Multiple examples of effective use of telemedicine now are available from practices caring for patients with several chronic gastrointestinal disorders. 76,[120][121][122][123][124][125][126][127][128] A remote patient monitoring process using smartphone apps that integrate directly into a large health system electronic medical record (EMR) (Epic) has been developed at Mount Sinai Hospital in New York City. 76 Patient-reported outcomes and decision support tools interact with the EMR so providers can view information in real time during the usual course of patient visits without changing to another platform.…”

Personalized Technologies in Chronic Gastrointestinal Disorders: Self-monitoring and Remote Sensor Technologies

“…Majority of patients having smartphones report using mobile apps for health needs ranging from health information search to wellness to managing their diseases through remote monitoring. 35,36 , According to the Fifth Annual Pulse of Online Health Survey, two-thirds of Americans are interested in using mobile phones and health apps to maintain their health, and 79% are willing to use wearable devices and remote health sensors. 37 At present, there are more than 165,000 apps dedicated to mobile health that are available for Android and iOS, a figure that has doubled during the last 2 years.…”

Tacking GI emergencies in India means and ways to improve it?

“…A smart app which can provide the necessary information for managing common GI emergencies on their finger tips can enhance patient care and as well provide training. 15,17 We, at PGIMER Chandigarh, recently designed a GI liver mobile app to provide a decision support tool for managing 15 common GI liver emergencies. It has been made in a user friendly, intuitive, easily navigatable colour coded actionable format.…”