Over half of Americans have at least one chronic disease, which include depression, diabetes, and hypertension. By definition, chronic diseases are 24/7 and impact all aspects of our patients' lives. It is thus patients themselves - through self-management of medication, lifestyle, exercise, and nutrition - who have the greatest potential to improve their disease states. Effective self-management requires timely and actionable feedback to patients on how their behavior impacts outcomes that are personally meaningful to them. Patient- reported outcomes (PROs) of symptoms such as depression, anxiety, mood, sleep, and cognitive function are of interest and meaningful to almost all patients with chronic conditions. When shared with providers, such PRO information can provide a singular view of the patient's perspective to inform shared decision-making. The ubiquitous nature of chronic diseases and the need for 24/7/anywhere data collection and feedback call for a mobile solution. With over 75% of Americans owning a smartphone, we can now use personal mobile technologies to collect and view PROs as never before possible. To date, we have secured key institutional support for a mobile PRO strategy at the University of California San Francisco (UCSF). UCSF's Division of General Internal Medicine (DGIM) serves a population of 25,000 primary care patients who reflect the ethnic and cultural diversity of the Bay Area, with over half of patients being racial/ethnic minorities and 21% Asian. Accordingly, we propose to develop the Mobile Patient-Reported Outcomes for Value and Effectiveness (mPROVE) system in English, Spanish, and Chinese for patient self-care and shared decision-making (Aim 1). Patients will use a smartphone app to collect and view PROs such as the PROMIS-29 and the novel Photographic Affect Meter visual PRO that assesses mood via a set of images. To make the PRO results seamlessly available to providers within their workflow, we will integrate mPROVE into UCSF's Epic electronic health record (EHR) and into UCSF's primary care workflow (Aim 2). We will use cutting-edge SMART-on-FHIR technology to embed PRO results into a window in the patient's EHR encounter without requiring any login by the provider. After conducting participatory design sessions, field testing, workflow prototyping, and pilot testing with patients, providers, and clinic staff, we will evaluate mPROVE using a Type 2 hybrid effectiveness-implementation study (Aim 3). Quality of care and implementation outcomes will be evaluated by a single-arm prospective interventional cohort study of 120 DGIM patients. Main effectiveness outcomes are PROMIS-29 health-related quality of life, shared decision-making, and self-efficacy. Main implementation outcomes include rates of PRO collection and PRO dashboard usage. mPROVE success will demonstrate a PRO intervention and implementation strategy that serves diverse populations, can be generalized to non-traditional PROs including novel visual PROs, and meets the needs of both patients and providers for using PROs in the care of patients with multiple chronic conditions.
The patient's perspective of their health and wellbeing is central to effective self-management of chronic diseases and for shared decision-making with care providers. This project will develop the Mobile Patient- Reported Outcomes for Value and Effectiveness (mPROVE) mobile app for patients to collect and view their own patient-reported outcomes (PROs), and will integrate these PRO results into the electronic health record for their care team to access.
