Uncontrolled asthma impairs quality of life for patients and is commonly associated with utilization of high-cost healthcare resources. Current clinical guidelines recommend frequent monitoring of asthma symptoms in the ambulatory setting to avoid clinical deterioration and emergency care. However, useful tools and practice models for intensive symptom monitoring are unavailable and adherence to these guidelines is poor. We have developed a simple mobile health (mHealth) app that can be installed on patients' smartphones to track and self-report asthma symptoms, and a practice model for clinics to monitor the patient-reported symptoms as part of routine care. As part of our current pilot, we have successfully implemented this app and practice model in a pulmonary subspecialty clinic and found high patient adherence, strong support for continued participation after 6 months of usage, and minimal burden on clinicians. The purpose of this project is to scale and spread this novel health IT-enabled practice model for the collection of patient-reported outcomes (PRO) between visits to the primary care setting. Specifically, we will (1) adapt our practice model and health IT tools to the primary care setting; (2) implement the health IT-enabled practice model in four primary care clinics affiliated with our accountable care organization that serves a diverse population, including Spanish-speaking and low health literacy patients; and (3) rigorously evaluate the effect on asthma-related patient-reported quality of life and healthcare utilization in a randomized controlled trial. If successful, this project will provide new knowledge about how to scale and spread a health IT-enabled practice model that incorporates the collection asthma- related PROs into routine primary care, the setting in which most asthma patients are treated. This work is innovative because it adapts an existing and proven health IT-enabled practice model that leverages widespread adoption of smartphones among patients and is guided by a novel framework specifically designed to scale and spread health technology innovations. Furthermore, our findings will produce rigorous evidence regarding impact, thereby providing a foundation for developing a set of best practices to scale and spread this or similar health IT-enabled practice models for between-visit collection of PROs for patients with asthma as well as other conditions.
As part of an effort to scale and spread the routine collection of asthma-related patient-reported outcomes, we will adapt, implement, and rigorously evaluate a new practice model and mobile health app to the primary care setting. The technology, practice model, and evidence that we generate from our study will provide the tools and best practices for primary care clinics to proactively monitor asthma symptoms between visits; improve the quality of life for asthma patients; and reduce asthma-related healthcare utilization, including urgent care and emergency room visits and hospitalizations. This approach will provide a model for other medical conditions that benefit from between-visit symptom monitoring.
