Core Components for a Clinically Integrated mHealth App for Asthma Symptom Monitoring
Published in: Applied Clinical Informatics, Volume 8, Issue 4 (November 2017), Pages 1031-1043. doi: 10.4338/ACI-2017-06-RA-0096
Posted on RAND.org on December 15, 2017
Health apps may be useful tools for supporting chronic disease management.
Our aim was to apply user-centered design principles to efficiently identify core components for an Health-based asthma symptom-monitoring intervention using patient-reported outcomes (PROs).
We iteratively combined principles of qualitative research, user-centered design, and "gamification" to understand patients' and providers' needs, develop and refine intervention components, develop prototypes, and create a usable mobile app to integrate with clinical workflows. We identified anticipated benefits and burdens for stakeholders.
We conducted 19 individual design sessions with nine adult patients and seven clinicians from an academic medical center (some were included multiple times). We identified four core intervention components: (1) Invitation- patients are invited by their physicians. (2) Symptom checks- patients receive weekly five-item questionnaires via the app with 48 hours to respond. Depending on symptoms, patients may be given the option to request a call from a nurse or receive one automatically. (3) Patient review- in the app, patients can view their self-reported data graphically. (4) In-person visit- physicians have access to patient-reported symptoms in the electronic health record (EHR) where they can review them before in-person visits. As there is currently no location in the EHR where physicians would consistently notice these data, recording a recent note was the best option. Benefits to patients may include helping decide when to call their provider and facilitating shared decision making. Benefits to providers may include saving time discussing symptoms. Provider organizations may need to pay nurses extra, but those costs may be offset by reduced visits and hospitalizations.
Recent systematic reviews show inconsistent outcomes and little insight into functionalities required for mHealth asthma interventions, highlighting the need for systematic intervention design. We identified specific features for adoption and engagement that meet the stated needs of users for asthma symptom monitoring.