Mobile App-based documentation of patient-reported outcomes — 3-months results from a proof-of-concept study on modern rheumatology patient management

Abstract

Background Mobile medical applications (Apps) offer innovative solutions for patients’ self-monitoring and new patient management opportunities. Prior to routine clinical application feasibility and acceptance of disease surveillance using an App that includes electronic (e) patient-reported outcome measures (PROMs) warrant evaluation. Therefore, we performed a proof-of-concept study in which rheumatoid arthritis (RA) patients used an App (RheumaLive) to document their disease. Methods Accurate PROM reporting via an App in comparison to paper-based versions was investigated to exclude media bias. Sixty participants recruited from 268 consecutive RA outpatients completed paper-based and electronic PROMs (Hannover Functional Questionnaire/derived HAQ; modified RA disease activity index) using the App at baseline and follow-up visits. Between visits, patients used their App on their own smartphone according to their preferences. The equivalence of PROM data and user experiences from patients and physicians were evaluated. Results Patients’ (78.3% female) mean (SD) age was 50.1 (13.1) years, disease duration 10.5 (9.1) years, and paper-based HAQ 0.78 (0.59). Mean confidence in Apps scored 3.5 (1.1, Likert scale 1 to 6). ePROMs’ scores obtained by patients’ data entry in the App were equivalent to paper-based ones and preferred by the patients. After 3 months, the App retention rate was 71.7%. Patients' overall satisfaction with the App was 2.2 (0.9, Likert scale 1 to 6). Patients and physicians valued the App, i.e., for patient-physician interaction: 87% reported that it was easier for them to document the course of the disease using the App than “only” answering questions about their current health during routine outpatient visits. Further App use was recommended in 77.3% of the patients, and according to physicians, in seven patients, the App use contributed to an increased adherence to therapy. Conclusion Our study provides an essential basis for the broader implementation of medical Apps in routine care. We demonstrated the feasibility and acceptance of disease surveillance using a smartphone App in RA. App use was convincing as a reliable option to perform continuous, remote monitoring of disease activity and treatment efficacy. Trial registration ClinicalTrials.gov, NCT02565225. Registered on September 16, 2015 (retrospectively registered).

A Narrative Literature Review of Bias in Collecting Patient Reported Outcomes Measures (PROMs)

“…One study compared the traditional paper based collection method with the use of an app for smartphones: No difference between the two methods was shown, neither at baseline nor at the follow-up visits, demonstrating that it is feasible to use an app as a collection method as a valid alternative to a paper based one [ 17 ].…”

Identifikation rheumatologischer Gesundheits-Apps im Apple App Store mit der Methode der „semiautomatischen retrospektiven App Store-Analyse“

“…Entsprechende organisatorische Strukturen wurden implementiert, weitere, detaillierte Ausgestaltungen sind in Vorbereitung. DiGAs sollen, um langfristig in das DiGA-Verzeichnis beim BfArM aufgenommen werden zu können, im klinischen Kontext – auch auf ihren Nutzen – geprüft werden [ 5 , 6 ], einzelne Ergebnisse zur Validität der mit Gesundheits-Apps erhobenen Daten liegen für die Rheumatologie vor [ 7 , 8 ].…”

“…Der Anwendung von Gesundheits-Apps werden vielversprechende Erfolgsaussichten zugeschrieben [ 7 , 9 ]. Postuliert wird ein großes Potenzial, die Gesundheit und das Patientenmanagement zu verbessern, aber es besteht auch hier eine erhebliche Heterogenität, z.…”

“…Für einen Teil der mit SARASA identifizierten Apps sind entsprechende MARS-Evaluationen publiziert [ 2 ]. Zur Praktikabilität und Anwendbarkeit in der klinischen Versorgung der anhand der SARASA-Methode und der von uns durch manuelle Überprüfung identifizierten Apps liegen nur einzelne Erfahrungen aus Proof-of-Concept-Studien vor [ 7 , 8 ].…”

Perceived Benefits, Barriers, and Facilitators of a Digital Patient-Reported Outcomes Tool for Routine Diabetes Care: Protocol for a National, Multicenter, Mixed Methods Implementation Study

“…Patient-reported outcome (PRO) questionnaires and PRO-based digital decision support tools, henceforth referred to as PRO tools, may help improve the quality of life and multiple person-centered aspects of quality of care for those with diabetes when appropriately designed for use in routine practice [ 1 - 3 ]. Depending on the purpose, content, and design of the tool, digital self-assessment and PRO tools have the potential to increase person-centered care in many ways [ 4 - 7 ].…”