A Mobile Health Application Integrated in the Electronic Health Record for Rheumatoid Arthritis Patient–Reported Outcomes: A Controlled Interrupted Time‐Series Analysis of Impact on Visit Efficiency
Objective Patient‐reported outcome (PRO) collection between visits for rheumatoid arthritis (RA) could improve visit efficiency, reducing in‐person visits for patients with stable symptoms while facilitating access for those with symptoms. We examined whether a mobile health PRO application integrat...
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| Veröffentlicht in: | Arthritis & rheumatology (Hoboken, N.J.) N.J.), 2024-05, Vol.76 (5), p.677-683 |
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| creator | Solomon, Daniel H. Altwies, Hallie Santacroce, Leah Ellrodt, Jack Pham, Tammy Stratton, Jacklyn Landman, Adam Dalal, Anuj Collins, Jamie Rudin, Robert S. |
| description | Objective
Patient‐reported outcome (PRO) collection between visits for rheumatoid arthritis (RA) could improve visit efficiency, reducing in‐person visits for patients with stable symptoms while facilitating access for those with symptoms. We examined whether a mobile health PRO application integrated in the electronic health record (EHR) could reduce visit volume for those with RA.
Methods
We developed an application for RA that prompted patients every other day to complete brief PRO questionnaires. Results of the application were integrated into the EHR. We tested the application in a controlled interrupted time‐series analysis between 2020 and 2023. Rheumatologists received EHR‐based messages based on PRO results recommending the patient receive a visit earlier or later than scheduled. The primary outcome was monthly visit volume during the year before versus the year after initiation.
Results
A total of 150 patients with RA consented and used the application. The median age was 62 years, 83% were female, 7% had fewer than 2 years of disease, and 50% were seropositive; 150 controls were well matched. Among those in the application cohort, the estimated monthly median visit volume in the year before use of the application was 31.2 (95% confidence interval [95% CI] 28.0–34.3); in controls, this was 30.4 (95% CI 27.3–33.6). In the year using the application, the estimated monthly visit volume was 36.8 (95% CI 33.4–40.3) compared to 38.7 (95% CI 35.2–42.3) in controls. The difference in the differences between the cohorts was not statistically significant (−2.7 visits, 95% CI −9.3 to 4.0). No differences were noted in flare rates or visit delays.
Conclusion
In this initial trial of a PRO application intervention to improve visit efficiency, we found no association with reduced visit volume. |
| doi_str_mv | 10.1002/art.42774 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_2902942354</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>3045299112</sourcerecordid><originalsourceid>FETCH-LOGICAL-c3134-f7e81e5c223cff9014fde13a1cdf551587559b7f8b44d8c5d6c7018523280d4b3</originalsourceid><addsrcrecordid>eNp1kc9uEzEQhy0EolXpgRdAlrjQQ1r_ze5yW0WBRioqCoHryusdE1fe9WJ7hXLrIyDxVjxGnwSHNByQ8GUs69M34_kh9JKSS0oIu1IhXQpWFOIJOmWczWeSEfn0eKcVPUHnMd6RfKqCzIl8jk54ScqilNUp-lXjD761DvA1KJe2uB5HZ7VK1g94NST4GlSCDtsBpy3gpQOdgh-sPvJr0D502PiA11uYepW87XAd0jbYZCP-mFUwpIf7n2sYfdi7bqekfQ_xLa7xwg_Z51x-3ncLYRr3yMb28HD_4xMECxHXg3K7mGXe4FU_Kp1wnu6LjTbhpTFW5w569wI9M8pFOH-sZ-jzu-VmcT27uX2_WtQ3M80pFzNTQElBasa4NqYiVJgOKFdUd0ZKKstCyqotTNkK0ZVadnNdEFrKvM-SdKLlZ-jNwTsG_22CmJreRg3OqQH8FBtWEVYJxqXI6Ot_0Ds_hfyb2HAiJKsqSlmmLg6UDj7GAKYZg-1V2DWUNPuMm5xx8yfjzL56NE5tD91f8phoBq4OwPcc6u7_pqZebw7K3yQEtNc</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>3045299112</pqid></control><display><type>article</type><title>A Mobile Health Application Integrated in the Electronic Health Record for Rheumatoid Arthritis Patient–Reported Outcomes: A Controlled Interrupted Time‐Series Analysis of Impact on Visit Efficiency</title><source>MEDLINE</source><source>Access via Wiley Online Library</source><creator>Solomon, Daniel H. ; Altwies, Hallie ; Santacroce, Leah ; Ellrodt, Jack ; Pham, Tammy ; Stratton, Jacklyn ; Landman, Adam ; Dalal, Anuj ; Collins, Jamie ; Rudin, Robert S.</creator><creatorcontrib>Solomon, Daniel H. ; Altwies, Hallie ; Santacroce, Leah ; Ellrodt, Jack ; Pham, Tammy ; Stratton, Jacklyn ; Landman, Adam ; Dalal, Anuj ; Collins, Jamie ; Rudin, Robert S.</creatorcontrib><description>Objective
Patient‐reported outcome (PRO) collection between visits for rheumatoid arthritis (RA) could improve visit efficiency, reducing in‐person visits for patients with stable symptoms while facilitating access for those with symptoms. We examined whether a mobile health PRO application integrated in the electronic health record (EHR) could reduce visit volume for those with RA.
Methods
We developed an application for RA that prompted patients every other day to complete brief PRO questionnaires. Results of the application were integrated into the EHR. We tested the application in a controlled interrupted time‐series analysis between 2020 and 2023. Rheumatologists received EHR‐based messages based on PRO results recommending the patient receive a visit earlier or later than scheduled. The primary outcome was monthly visit volume during the year before versus the year after initiation.
Results
A total of 150 patients with RA consented and used the application. The median age was 62 years, 83% were female, 7% had fewer than 2 years of disease, and 50% were seropositive; 150 controls were well matched. Among those in the application cohort, the estimated monthly median visit volume in the year before use of the application was 31.2 (95% confidence interval [95% CI] 28.0–34.3); in controls, this was 30.4 (95% CI 27.3–33.6). In the year using the application, the estimated monthly visit volume was 36.8 (95% CI 33.4–40.3) compared to 38.7 (95% CI 35.2–42.3) in controls. The difference in the differences between the cohorts was not statistically significant (−2.7 visits, 95% CI −9.3 to 4.0). No differences were noted in flare rates or visit delays.
Conclusion
In this initial trial of a PRO application intervention to improve visit efficiency, we found no association with reduced visit volume.</description><identifier>ISSN: 2326-5191</identifier><identifier>EISSN: 2326-5205</identifier><identifier>DOI: 10.1002/art.42774</identifier><identifier>PMID: 38087859</identifier><language>eng</language><publisher>Boston, USA: Wiley Periodicals, Inc</publisher><subject>Aged ; Arthritis ; Arthritis, Rheumatoid - drug therapy ; Autoimmune diseases ; Efficiency ; Electronic Health Records ; Electronic medical records ; Female ; Humans ; Impact analysis ; Interrupted Time Series Analysis ; Male ; Middle Aged ; Mobile Applications ; Office Visits - statistics & numerical data ; Patient Reported Outcome Measures ; Patients ; Rheumatoid arthritis ; Signs and symptoms ; Statistical analysis ; Surveys and Questionnaires ; Telemedicine ; Telemedicine - methods</subject><ispartof>Arthritis & rheumatology (Hoboken, N.J.), 2024-05, Vol.76 (5), p.677-683</ispartof><rights>2023 American College of Rheumatology</rights><rights>2023 American College of Rheumatology.</rights><rights>2024 American College of Rheumatology</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><cites>FETCH-LOGICAL-c3134-f7e81e5c223cff9014fde13a1cdf551587559b7f8b44d8c5d6c7018523280d4b3</cites><orcidid>0000-0001-8413-007X ; 0009-0004-0996-0339 ; 0000-0001-8951-2296 ; 0000-0001-8202-5428</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://onlinelibrary.wiley.com/doi/pdf/10.1002%2Fart.42774$$EPDF$$P50$$Gwiley$$H</linktopdf><linktohtml>$$Uhttps://onlinelibrary.wiley.com/doi/full/10.1002%2Fart.42774$$EHTML$$P50$$Gwiley$$H</linktohtml><link.rule.ids>315,781,785,1418,27926,27927,45576,45577</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/38087859$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Solomon, Daniel H.</creatorcontrib><creatorcontrib>Altwies, Hallie</creatorcontrib><creatorcontrib>Santacroce, Leah</creatorcontrib><creatorcontrib>Ellrodt, Jack</creatorcontrib><creatorcontrib>Pham, Tammy</creatorcontrib><creatorcontrib>Stratton, Jacklyn</creatorcontrib><creatorcontrib>Landman, Adam</creatorcontrib><creatorcontrib>Dalal, Anuj</creatorcontrib><creatorcontrib>Collins, Jamie</creatorcontrib><creatorcontrib>Rudin, Robert S.</creatorcontrib><title>A Mobile Health Application Integrated in the Electronic Health Record for Rheumatoid Arthritis Patient–Reported Outcomes: A Controlled Interrupted Time‐Series Analysis of Impact on Visit Efficiency</title><title>Arthritis & rheumatology (Hoboken, N.J.)</title><addtitle>Arthritis Rheumatol</addtitle><description>Objective
Patient‐reported outcome (PRO) collection between visits for rheumatoid arthritis (RA) could improve visit efficiency, reducing in‐person visits for patients with stable symptoms while facilitating access for those with symptoms. We examined whether a mobile health PRO application integrated in the electronic health record (EHR) could reduce visit volume for those with RA.
Methods
We developed an application for RA that prompted patients every other day to complete brief PRO questionnaires. Results of the application were integrated into the EHR. We tested the application in a controlled interrupted time‐series analysis between 2020 and 2023. Rheumatologists received EHR‐based messages based on PRO results recommending the patient receive a visit earlier or later than scheduled. The primary outcome was monthly visit volume during the year before versus the year after initiation.
Results
A total of 150 patients with RA consented and used the application. The median age was 62 years, 83% were female, 7% had fewer than 2 years of disease, and 50% were seropositive; 150 controls were well matched. Among those in the application cohort, the estimated monthly median visit volume in the year before use of the application was 31.2 (95% confidence interval [95% CI] 28.0–34.3); in controls, this was 30.4 (95% CI 27.3–33.6). In the year using the application, the estimated monthly visit volume was 36.8 (95% CI 33.4–40.3) compared to 38.7 (95% CI 35.2–42.3) in controls. The difference in the differences between the cohorts was not statistically significant (−2.7 visits, 95% CI −9.3 to 4.0). No differences were noted in flare rates or visit delays.
Conclusion
In this initial trial of a PRO application intervention to improve visit efficiency, we found no association with reduced visit volume.</description><subject>Aged</subject><subject>Arthritis</subject><subject>Arthritis, Rheumatoid - drug therapy</subject><subject>Autoimmune diseases</subject><subject>Efficiency</subject><subject>Electronic Health Records</subject><subject>Electronic medical records</subject><subject>Female</subject><subject>Humans</subject><subject>Impact analysis</subject><subject>Interrupted Time Series Analysis</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Mobile Applications</subject><subject>Office Visits - statistics & numerical data</subject><subject>Patient Reported Outcome Measures</subject><subject>Patients</subject><subject>Rheumatoid arthritis</subject><subject>Signs and symptoms</subject><subject>Statistical analysis</subject><subject>Surveys and Questionnaires</subject><subject>Telemedicine</subject><subject>Telemedicine - methods</subject><issn>2326-5191</issn><issn>2326-5205</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2024</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp1kc9uEzEQhy0EolXpgRdAlrjQQ1r_ze5yW0WBRioqCoHryusdE1fe9WJ7hXLrIyDxVjxGnwSHNByQ8GUs69M34_kh9JKSS0oIu1IhXQpWFOIJOmWczWeSEfn0eKcVPUHnMd6RfKqCzIl8jk54ScqilNUp-lXjD761DvA1KJe2uB5HZ7VK1g94NST4GlSCDtsBpy3gpQOdgh-sPvJr0D502PiA11uYepW87XAd0jbYZCP-mFUwpIf7n2sYfdi7bqekfQ_xLa7xwg_Z51x-3ncLYRr3yMb28HD_4xMECxHXg3K7mGXe4FU_Kp1wnu6LjTbhpTFW5w569wI9M8pFOH-sZ-jzu-VmcT27uX2_WtQ3M80pFzNTQElBasa4NqYiVJgOKFdUd0ZKKstCyqotTNkK0ZVadnNdEFrKvM-SdKLlZ-jNwTsG_22CmJreRg3OqQH8FBtWEVYJxqXI6Ot_0Ds_hfyb2HAiJKsqSlmmLg6UDj7GAKYZg-1V2DWUNPuMm5xx8yfjzL56NE5tD91f8phoBq4OwPcc6u7_pqZebw7K3yQEtNc</recordid><startdate>202405</startdate><enddate>202405</enddate><creator>Solomon, Daniel H.</creator><creator>Altwies, Hallie</creator><creator>Santacroce, Leah</creator><creator>Ellrodt, Jack</creator><creator>Pham, Tammy</creator><creator>Stratton, Jacklyn</creator><creator>Landman, Adam</creator><creator>Dalal, Anuj</creator><creator>Collins, Jamie</creator><creator>Rudin, Robert S.</creator><general>Wiley Periodicals, Inc</general><general>Wiley Subscription Services, Inc</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7QL</scope><scope>7QP</scope><scope>7T5</scope><scope>7TM</scope><scope>7U7</scope><scope>C1K</scope><scope>H94</scope><scope>K9.</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0001-8413-007X</orcidid><orcidid>https://orcid.org/0009-0004-0996-0339</orcidid><orcidid>https://orcid.org/0000-0001-8951-2296</orcidid><orcidid>https://orcid.org/0000-0001-8202-5428</orcidid></search><sort><creationdate>202405</creationdate><title>A Mobile Health Application Integrated in the Electronic Health Record for Rheumatoid Arthritis Patient–Reported Outcomes: A Controlled Interrupted Time‐Series Analysis of Impact on Visit Efficiency</title><author>Solomon, Daniel H. ; Altwies, Hallie ; Santacroce, Leah ; Ellrodt, Jack ; Pham, Tammy ; Stratton, Jacklyn ; Landman, Adam ; Dalal, Anuj ; Collins, Jamie ; Rudin, Robert S.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c3134-f7e81e5c223cff9014fde13a1cdf551587559b7f8b44d8c5d6c7018523280d4b3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2024</creationdate><topic>Aged</topic><topic>Arthritis</topic><topic>Arthritis, Rheumatoid - drug therapy</topic><topic>Autoimmune diseases</topic><topic>Efficiency</topic><topic>Electronic Health Records</topic><topic>Electronic medical records</topic><topic>Female</topic><topic>Humans</topic><topic>Impact analysis</topic><topic>Interrupted Time Series Analysis</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Mobile Applications</topic><topic>Office Visits - statistics & numerical data</topic><topic>Patient Reported Outcome Measures</topic><topic>Patients</topic><topic>Rheumatoid arthritis</topic><topic>Signs and symptoms</topic><topic>Statistical analysis</topic><topic>Surveys and Questionnaires</topic><topic>Telemedicine</topic><topic>Telemedicine - methods</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Solomon, Daniel H.</creatorcontrib><creatorcontrib>Altwies, Hallie</creatorcontrib><creatorcontrib>Santacroce, Leah</creatorcontrib><creatorcontrib>Ellrodt, Jack</creatorcontrib><creatorcontrib>Pham, Tammy</creatorcontrib><creatorcontrib>Stratton, Jacklyn</creatorcontrib><creatorcontrib>Landman, Adam</creatorcontrib><creatorcontrib>Dalal, Anuj</creatorcontrib><creatorcontrib>Collins, Jamie</creatorcontrib><creatorcontrib>Rudin, Robert S.</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Bacteriology Abstracts (Microbiology B)</collection><collection>Calcium & Calcified Tissue Abstracts</collection><collection>Immunology Abstracts</collection><collection>Nucleic Acids Abstracts</collection><collection>Toxicology Abstracts</collection><collection>Environmental Sciences and Pollution Management</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>MEDLINE - Academic</collection><jtitle>Arthritis & rheumatology (Hoboken, N.J.)</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Solomon, Daniel H.</au><au>Altwies, Hallie</au><au>Santacroce, Leah</au><au>Ellrodt, Jack</au><au>Pham, Tammy</au><au>Stratton, Jacklyn</au><au>Landman, Adam</au><au>Dalal, Anuj</au><au>Collins, Jamie</au><au>Rudin, Robert S.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>A Mobile Health Application Integrated in the Electronic Health Record for Rheumatoid Arthritis Patient–Reported Outcomes: A Controlled Interrupted Time‐Series Analysis of Impact on Visit Efficiency</atitle><jtitle>Arthritis & rheumatology (Hoboken, N.J.)</jtitle><addtitle>Arthritis Rheumatol</addtitle><date>2024-05</date><risdate>2024</risdate><volume>76</volume><issue>5</issue><spage>677</spage><epage>683</epage><pages>677-683</pages><issn>2326-5191</issn><eissn>2326-5205</eissn><abstract>Objective
Patient‐reported outcome (PRO) collection between visits for rheumatoid arthritis (RA) could improve visit efficiency, reducing in‐person visits for patients with stable symptoms while facilitating access for those with symptoms. We examined whether a mobile health PRO application integrated in the electronic health record (EHR) could reduce visit volume for those with RA.
Methods
We developed an application for RA that prompted patients every other day to complete brief PRO questionnaires. Results of the application were integrated into the EHR. We tested the application in a controlled interrupted time‐series analysis between 2020 and 2023. Rheumatologists received EHR‐based messages based on PRO results recommending the patient receive a visit earlier or later than scheduled. The primary outcome was monthly visit volume during the year before versus the year after initiation.
Results
A total of 150 patients with RA consented and used the application. The median age was 62 years, 83% were female, 7% had fewer than 2 years of disease, and 50% were seropositive; 150 controls were well matched. Among those in the application cohort, the estimated monthly median visit volume in the year before use of the application was 31.2 (95% confidence interval [95% CI] 28.0–34.3); in controls, this was 30.4 (95% CI 27.3–33.6). In the year using the application, the estimated monthly visit volume was 36.8 (95% CI 33.4–40.3) compared to 38.7 (95% CI 35.2–42.3) in controls. The difference in the differences between the cohorts was not statistically significant (−2.7 visits, 95% CI −9.3 to 4.0). No differences were noted in flare rates or visit delays.
Conclusion
In this initial trial of a PRO application intervention to improve visit efficiency, we found no association with reduced visit volume.</abstract><cop>Boston, USA</cop><pub>Wiley Periodicals, Inc</pub><pmid>38087859</pmid><doi>10.1002/art.42774</doi><tpages>7</tpages><orcidid>https://orcid.org/0000-0001-8413-007X</orcidid><orcidid>https://orcid.org/0009-0004-0996-0339</orcidid><orcidid>https://orcid.org/0000-0001-8951-2296</orcidid><orcidid>https://orcid.org/0000-0001-8202-5428</orcidid></addata></record> |
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| ispartof | Arthritis & rheumatology (Hoboken, N.J.), 2024-05, Vol.76 (5), p.677-683 |
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| source | MEDLINE; Access via Wiley Online Library |
| subjects | Aged Arthritis Arthritis, Rheumatoid - drug therapy Autoimmune diseases Efficiency Electronic Health Records Electronic medical records Female Humans Impact analysis Interrupted Time Series Analysis Male Middle Aged Mobile Applications Office Visits - statistics & numerical data Patient Reported Outcome Measures Patients Rheumatoid arthritis Signs and symptoms Statistical analysis Surveys and Questionnaires Telemedicine Telemedicine - methods |
| title | A Mobile Health Application Integrated in the Electronic Health Record for Rheumatoid Arthritis Patient–Reported Outcomes: A Controlled Interrupted Time‐Series Analysis of Impact on Visit Efficiency |
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