RESUMEN
BACKGROUND: Migraine is a common and major cause of disability, poor quality of life, and high health care use. Access to evidence-based migraine care is limited and projected to worsen. Novel mobile health app-based tools may effectively deliver migraine patient education to support self-management, facilitate remote monitoring and treatment, and improve access to care. The risk that such an intervention may increase the care team workload is a potential implementation barrier. OBJECTIVE: This study aims to describe a novel electronic health record-integrated mobile app-based Migraine Interactive Care Plan (MICP) and evaluate its feasibility, usability, and impact on care teams in a community neurology practice. METHODS: Consecutive enrollees between September 1, 2020, and February 16, 2022, were assessed in a single-arm observational study of usability, defined by 74.3% (127/171) completing ≥1 assigned task. Task response rates, rate and type of care team escalations, and patient-reported outcomes were summarized. Patients were prospectively recruited and randomly assigned to routine care with or without the MICP from September 1, 2020, to September 1, 2021. Feasibility was defined by equal to or fewer downstream face-to-face visits, telephone contacts, and electronic messages in the MICP cohort. The Wilcoxon rank-sum test was used to compare continuous variables, and the chi-square test was used for categorical variables for those with at least 3 months of follow-up. RESULTS: A total of 171 patients were enrolled, and of these, 127 (74.3%) patients completed ≥1 MICP-assigned task. Mean escalations per patient per month was 0.9 (SD 0.37; range 0-1.7). Patient-confirmed understanding of the educational materials ranged from 26.6% (45/169) to 56.2% (95/169). Initial mean headache days per week was 4.54 (SD 2.06) days and declined to 2.86 (SD 1.87) days at week 26. The percentage of patients reporting favorable satisfaction increased from a baseline of 35% (20/57) to 83% (15/18; response rate of 42/136, 30.9% to 28/68, 41%) over the first 6 months. A total of 121 patients with MICP were compared with 62 patients in the control group. No differences were observed in the rate of telephone contacts or electronic messages. Fewer face-to-face visits were observed in the MICP cohort (13/121, 10.7%) compared with controls (26/62, 42%; P<.001). CONCLUSIONS: We describe the successful implementation of an electronic health record-integrated mobile app-based care plan for migraine in a community neurology practice. We observed fewer downstream face-to-face visits without increasing telephone calls, medication refills, or electronic messages. Our findings suggest that the MICP has the potential to improve patient access without increasing care team workload and the need for patient input from diverse populations to improve and sustain patient engagement. Additional studies are needed to assess its impact in primary care.
RESUMEN
PURPOSE: To assess the feasibility of an app-based, electronic health record (EHR)-integrated, interactive care plan (ICP) for breast cancer (BC) survivors. METHODS: A single-arm pilot study was conducted with female BC survivors. ICP tasks included quarterly quality of life (QOL) questionnaire; monthly assessments of fatigue, insomnia, sexual dysfunction, hot flashes, and recurrence symptoms; and daily activity reminders. Embedded decision trees escalated recurrence symptoms to providers. On-demand education was available for self-management of treatment-related toxicities. The primary objective was to assess patients' engagement with ICP tasks against feasibility thresholds of 75% completion rate. Secondary objectives were evaluation of the system's functionality to track and escalate symptoms appropriately, and care team impact measured by volume of escalation messages generated. We report preliminary results 6 months after the last patient enrolled. RESULTS: Twenty-three patients enrolled August to November 2020. Mean age was 50.1 years. All patients engaged with at least one ICP task. The monthly average task completion rates were 62% for the QOL questionnaire, 59% for symptom assessments, and 37% for activity reminders. Task completion rate decreased over time. Eleven of 253 symptoms and QOL questionnaires (4.3%) generated messages for care escalation. CONCLUSION: Implementation of an app-based, EHR-integrated ICP in BC survivors was feasible and created minimal provider burden; however, patient engagement was below the feasibility threshold suggesting that changes may enhance broad implementation and adoption. IMPLICATIONS FOR CANCER SURVIVORS: An ICP may facilitate remote monitoring, symptom control, and recurrence surveillance for cancer survivors as strategies to enhance patient engagement are applied.
