Liss David T, Brown Tiffany, Wakeman Julie, Dunn Shira, Cesan Ana, Guzman Adriana, Desai Amish, Buchanan David
Division of General Internal Medicine and Geriatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.
Erie Family Health Centers, Chicago, Illinois, USA.
Telemed J E Health. 2020 Nov;26(11):1391-1399. doi: 10.1089/tmj.2019.0176. Epub 2020 Feb 10.
Despite widespread adoption of health information technology, U.S. providers face persistent barriers to coordination of care. We sought to develop and implement a patient-centered smartphone app that facilitates care coordination when patients receive care at any hospital in a region. Partnering with patients and primary care teams at a federally qualified health center (FQHC), we developed an app that (1) used real-time location data to identify encounters at 41 regional hospitals; (2) sent notifications to users' phones, asking them to confirm hospital arrival/discharge, and; (3) sent automated messages to primary care teams about confirmed hospital encounters. App design included multiple, successive rounds of active patient participation. In a small beta test of the initial version of the app, high-risk, low-income FQHC patients ran the app on their phone for 3 months. A formative mixed methods evaluation examined the app's technical performance and user experience. Twelve patients enrolled in the beta test and provided follow-up data; 11 (92%) were racial/ethnic minorities. Participants obtained emergency or inpatient care at four regional hospitals. The app had 75% sensitivity to detect events when notifications should have fired, and 90% positive predictive value (PPV) of events when notifications fired. Barriers to implementation related to the app's user interface and the performance of its location tracking algorithm. We partnered with patients from a traditionally underserved population to develop a new smartphone-based approach to regional care coordination. The app had moderate sensitivity and high PPV for identifying regional hospital visits.
尽管健康信息技术已得到广泛应用，但美国的医疗服务提供者在医疗协调方面仍面临持续障碍。我们试图开发并实施一款以患者为中心的智能手机应用程序，以便在患者于某地区的任何医院接受治疗时促进医疗协调。我们与一家联邦合格健康中心（FQHC）的患者及初级保健团队合作，开发了一款应用程序，该程序能够：（1）利用实时位置数据识别41家地区医院的就诊情况；（2）向用户手机发送通知，要求他们确认入院/出院情况；（3）就已确认的医院就诊情况向初级保健团队发送自动消息。应用程序的设计包括多轮、连续的患者积极参与环节。在对该应用程序初始版本进行的小型测试版测试中，高风险、低收入的FQHC患者在其手机上运行该应用程序达3个月。一项形成性混合方法评估考察了该应用程序的技术性能和用户体验。12名患者参与了测试版测试并提供了后续数据；其中11名（92%）为少数族裔。参与者在四家地区医院接受了急诊或住院治疗。该应用程序在通知应触发时检测事件的灵敏度为75%，在通知触发时事件的阳性预测值（PPV）为90%。实施过程中的障碍与应用程序的用户界面及其位置跟踪算法的性能有关。我们与来自传统上服务不足人群的患者合作，开发了一种基于智能手机的新方法来进行地区医疗协调。该应用程序在识别地区医院就诊方面具有中等灵敏度和较高的PPV。
