Division of General Internal Medicine Primary Care, Brigham and Women's Hospital, Boston, Massachusetts, United States.
Harvard Medical School, Boston, Massachusetts, United States.
Appl Clin Inform. 2024 Aug;15(4):785-797. doi: 10.1055/s-0044-1788978. Epub 2024 Oct 2.
This study aimed to evaluate implementation of a digital remote symptom monitoring intervention that delivered weekly symptom questionnaires and included the option to receive nurse callbacks via a mobile app for asthma patients in primary care.
Research questions were structured by the NASSS (Nonadoption, Abandonment, Scale-up Spread, and Sustainability) framework. Quantitative and qualitative methods assessed scalability of the electronic health record (EHR)-integrated app intervention implemented in a 12-month randomized controlled trial. Data sources included patient asthma control questionnaires; app usage logs; EHRs; and interviews and discussions with patients, primary care providers (PCPs), and nurses.
We included app usage data from 190 patients and interview data from 21 patients and several clinician participants. Among 190 patients, average questionnaire completion rate was 72.3% and retention was 78.9% (i.e., 150 patients continued to use the app at the end of the trial period). App use was lower among Hispanic and younger patients and those with fewer years of education. Of 1,185 nurse callback requests offered to patients. Thirty-three (2.8%) were requested. Of 84 PCP participants, 14 (16.7%) accessed the patient-reported data in the EHR. Analyses showed that the intervention was appropriate for all levels of asthma control; had no major technical barriers; was desirable and useful for patient treatment; involved achievable tasks for patients; required modest role changes for clinicians; and was a minimal burden on the organization.
A clinically integrated symptom monitoring intervention has strong potential for sustained adoption. Inequitable adoption remains a concern. PCP use of patient-reported data during visits could improve intervention adoption but may not be required for patient benefits.
本研究旨在评估一项数字远程症状监测干预措施的实施情况，该干预措施通过移动应用程序每周向患者发送症状问卷，并提供护士回拨服务，适用于初级保健中的哮喘患者。
研究问题是根据 NASSS（不采用、放弃、扩展、可持续性）框架构建的。采用定量和定性方法评估了在为期 12 个月的随机对照试验中实施的与电子病历（EHR）集成的应用程序干预措施的可扩展性。数据来源包括患者哮喘控制问卷、应用程序使用日志、EHR 以及对患者、初级保健提供者（PCP）和护士的访谈和讨论。
我们纳入了 190 名患者的应用程序使用数据和 21 名患者以及几位临床医生参与者的访谈数据。在 190 名患者中，平均问卷完成率为 72.3%，保留率为 78.9%（即 150 名患者在试验结束时继续使用该应用程序）。应用程序使用率较低的患者为西班牙裔、年轻患者以及教育程度较低的患者。在提供给患者的 1185 次护士回拨请求中，有 33 次（2.8%）被请求。在 84 名 PCP 参与者中，有 14 名（16.7%）在 EHR 中查看了患者报告的数据。分析表明，该干预措施适用于所有哮喘控制水平；没有重大技术障碍；对患者治疗是理想和有用的；患者可以完成干预措施的要求；对临床医生的角色改变要求不高；对组织的负担也较小。
一种临床集成的症状监测干预措施具有持续采用的强大潜力。采用的不平等仍然是一个问题。PCP 在就诊期间使用患者报告的数据可能会提高干预措施的采用率，但可能不是患者获益所必需的。
