Solomon Daniel H, Dalal Anuj K, Landman Adam B, Santacroce Leah, Altwies Hallie, Stratton Jackie, Rudin Robert S
Brigham and Women's Hospital, Boston, Massachusetts.
RAND Corporation, Boston, Massachusetts.
ACR Open Rheumatol. 2022 Nov;4(11):964-973. doi: 10.1002/acr2.11498. Epub 2022 Sep 13.
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.
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.
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.
PRO apps may improve care efficiency in rheumatology. Formal evaluation of an integrated PRO RA app is forthcoming.
由于劳动力短缺，许多类风湿关节炎（RA）患者难以找到临床医生为其治疗。我们开发了一款应用程序来解决这一问题，通过提高护理效率。该应用程序收集患者报告的结果（PROs），可用于告知就诊时间，有可能减少低价值就诊的数量。我们描述了该应用程序的开发过程、干预设计以及测试该应用程序的计划研究。
我们采用以用户为中心的设计方法，采访患者和临床医生来开发该应用程序。为提高就诊效率，症状跟踪逻辑会向临床医生提醒PROs的趋势：PROs恶化会生成提醒，建议提前就诊，而PROs稳定或改善则会生成通知，提示预定就诊可能推迟。对非随机对照人群进行中断时间序列分析，将有助于评估该应用程序对就诊频率的影响。
患者访谈确定了有效应用程序和干预设计的以下几个需求：简单用户界面便于快速回答PROs的重要性、提供浓缩摘要信息并链接到关于RA常见问题的更深入答案，以及临床医生在与患者就诊期间讨论PRO数据的必要性。临床医生访谈确定了以下用户需求：PRO数据在临床工作流程中必须易于查看和使用，并且当PROs趋势恶化时应减少定期就诊。一些临床医生认为PROs稳定的患者就诊可以推迟，而另一些人则提出了担忧。
PRO应用程序可能会提高风湿病学的护理效率。即将对一款集成的PRO RA应用程序进行正式评估。
