User-centered design of a scalable, electronic health record-integrated remote symptom monitoring intervention for patients with asthma and providers in primary care

Rudin, Robert S.; Pérez, Sofía; Rodriguez, Jorge A.; Sousa, Jessica L.; Plombon, Savanna; Arcia, Adriana; Foer, Dinah; Bates, David W.; Dalal, Anuj K.

doi:10.1093/jamia/ocab157

Cited by 24 publications

(15 citation statements)

References 55 publications

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“…In addition, routine collection of PROs is a recommended aspect of clinical care for patients with symptomatic conditions (5,24). Based on our work in other chronic symptomatic conditions, for example, asthma (22,25,26), we believe that a PRO app can be developed as a platform that could facilitate tracking symptoms across multiple conditions. We are beginning to think through other rheumatic diseases in which a PRO app may be useful.…”

Section: Discussionmentioning

confidence: 99%

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Development and Testing of an Electronic Health Record‐Integrated Patient‐Reported Outcome Application and Intervention to Improve Efficiency of Rheumatoid Arthritis Care

Solomon

Dalal

Landman

et al. 2022

ACR Open Rheumatology

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Objective. Many patients with rheumatoid arthritis (RA) have difficulty finding clinicians to treat them because of workforce shortages. We developed an app to address this problem by improving care efficiency. The app collects patient-reported outcomes (PROs) and can be used to inform visit timing, potentially reducing the volume of low-value visits. We describe the development process, intervention design, and planned study for testing the app.Methods. We employed user-centered design, interviewing patients and clinicians, to develop the app. To improve visit efficiency, symptom tracking logic alerts clinicians to PRO trends: worsening PROs generate alerts suggesting an earlier visit, and stable or improving PROs generate notifications that scheduled visits could be delayed. An interrupted time-series analysis with a nonrandomized control population will allow assessment of the impact of the app on visit frequency.Results. Patient interviews identified several of the following needs for effective app and intervention design: the importance of a simple user interface facilitating rapid answering of PROs, the availability of condensed summary information with links to more in-depth answers to common questions regarding RA, and the need for clinicians to discuss the PRO data during visits with patients. Clinician interviews identified the following user needs: PRO data must be easy to view and use during the clinical workflow, and there should be reduced interval visits when PROs are trending worse. Some clinicians believed visits could be delayed for patients with stable PROs, whereas others raised concerns.Conclusion. PRO apps may improve care efficiency in rheumatology. Formal evaluation of an integrated PRO RA app is forthcoming.

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Section: Discussionmentioning

confidence: 99%

“…Integration in the EHR. As we have done previously for other apps (22), we integrated the app into the EHR. Although the data are not stored in the EHR, a "web frame" from the RA app is viewable from the chart.…”

Section: Methodsmentioning

confidence: 99%

Development and Testing of an Electronic Health Record‐Integrated Patient‐Reported Outcome Application and Intervention to Improve Efficiency of Rheumatoid Arthritis Care

Solomon

Dalal

Landman

et al. 2022

ACR Open Rheumatology

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“…Even though the developers of the NASSS give quite detailed guidance for classifying data into the seven domains [44], we found it necessary to use two strategies to make an adequate classi cation. The rst was to consider how others had interpreted the seven domains of the NASSS [26, 41,56,57,58]. The second was when focus group members' statements could be classi ed in more than one domain, for example, "the app.…”

Section: Discussionmentioning

confidence: 99%

Digital primary and community healthcare: practitioner’s experience in Stockholm during the Covid-19 pandemic and future development

Solberg-Carlsson

Øvretveit

Ohrling

2022

Preprint

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Background: Health care organizations report that that the Covid-19 pandemic accelerated their use of digital technologies. We wanted to better understand how rapid and large scale-up took place without any systematic implementation in public primary and community health care in the Stockholm region, Sweden, as well as future development plans. Methods: Qualitative data from twelve focus group interviews with clinical managers (n=99) were analysed using a directed content analysis. The seven domains of the Non-adoption, Abandonment, and challenges to the Scale-up, Spread and Sustainability (NASSS) framework was used to understand the implementation process, as described by the clinical managers in the focus groups. Results: The participants reported that they made their own local decisions to make more use of the existing technology provided by the health system for appointments, video and telephone calls. Most participants took the view that the technology was ready to use, despite some limitations. Most challenges for making more use of the technology that were reported were individual clinician’s and patient preferences, how ready their unit was for making changes to practice and organisation. Some raised concerns about how standardizing some aspects possibly conflicted with the decentralised management model of the organisation. The overall experience was reported to be positive, with an intention to sustain the achievements. Conclusions: Focus group interviews found that that unit managers were positive about the digital technology system for remote care. For the future, they wanted changes to be made at different levels of the health system to help them to better combine digital and physical care in their unit. Possibilities to use digital technology to integrate primary and hospital health care were identified.

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“…The intervention was initially designed and tested in subspecialty pulmonary care, and expanded to the primary care setting for this study. 18,19 We used a user-centered approach to design the application, and an implementation framework (nonadoption, abandonment, scale-up, spread, sustainability [NASSS]) to maximize scalability. 20 The patient-facing components of the intervention included an app that prompts patients to complete weekly ePRO questionnaires and offers patients the option to request a callback from a clinic nurse when symptoms worsen.…”

Section: Overview and Study Designmentioning

confidence: 99%

“…The clinician practice model included an EHR-integrated dashboard showing a summary of the ePRO trends for clinicians, and previsit reminders to prompt both patients and clinicians to discuss reported asthma symptoms during clinic appointments. 18 The intervention was designed to be usable and beneficial for any patient with asthma of varying severity. 21 We conducted a prospective study of the recruitment methods used to screen, approach, and enroll patients into our RCT which will evaluate the impact of the digital intervention on asthma-related quality of life measured by the Mini Asthma Quality of Life Questionnaire (mini-AQLQ), a validated, patient-reported measure.…”

Section: Overview and Study Designmentioning

confidence: 99%

Assessing Equitable Recruitment in a Digital Health Trial for Asthma

Plombon,

S. Rudin,

Sulca Flores

et al. 2023

Appl Clin Inform

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Objective: To assess a multi-pronged strategy using primarily digital methods to equitably recruit asthma patients into a clinical trial of a digital health intervention. Methods: We approached eligible patients using at least one of eight recruitment strategies. We recorded approach dates and the strategy that led to completion of a web-based eligibility questionnaire that was reported during the verbal consent phone call. Study team members conducted monthly sessions using a structured guide to identify recruitment barriers and facilitators. The proportion of participants who reported being recruited by a portal or non-portal strategy was measured as our outcomes. We used Fisher’s Exact test to compare outcomes by equity variable, and multivariable logistic regression to control for each covariate and adjust effect size estimates. Using grounded theory, we coded and extracted themes regarding recruitment barriers and facilitators. Results: The majority (84.4%) of patients who met study inclusion criteria were patient portal enrollees. Of 6366 eligible patients who were approached, 627 completed the eligibility questionnaire and were less frequently Hispanic, less frequently Spanish-speaking, and more frequently patient portal enrollees. Of 445 patients who consented to participate, 241 (54.2%) reported completing the eligibility questionnaire after being contacted by a patient portal message. In adjusted analysis, only race (OR 0.46 [(0.28, 0.77)], p=0.003) and college education (OR 0.60, 95% CI [0.39, 0.91], p = 0.016) remained significant. Key recruitment barriers included technology issues (e.g., lack of email access) and facilitators included bilingual study staff, Spanish-language recruitment materials, targeted phone calls, and clinician-initiated “1-click” referrals. Discussion/Conclusion: A primarily digital strategy to recruit patients into a digital health trial is unlikely to achieve equitable participation, even in a population overrepresented by patient portal enrollees. Non-digital recruitment methods that address racial and educational disparities and less active portal enrollees are necessary to ensure equity in clinical trial enrollment.

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User-centered design of a scalable, electronic health record-integrated remote symptom monitoring intervention for patients with asthma and providers in primary care

Cited by 24 publications

References 55 publications

Development and Testing of an Electronic Health Record‐Integrated Patient‐Reported Outcome Application and Intervention to Improve Efficiency of Rheumatoid Arthritis Care

Development and Testing of an Electronic Health Record‐Integrated Patient‐Reported Outcome Application and Intervention to Improve Efficiency of Rheumatoid Arthritis Care

Digital primary and community healthcare: practitioner’s experience in Stockholm during the Covid-19 pandemic and future development

Assessing Equitable Recruitment in a Digital Health Trial for Asthma

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