P-215 Pilot Testing of an mHealth Tool to Improve Inter-visit Clinical Care for Pediatric IBD

Abstract

Background: The availability of continuous access to care, while important to the chronic care model, is not easily achieved in most practice settings. Advances in technology offer the potential to optimize patient-clinician collaboration and communication, and enable "just in time" care. Mobile Health (mHealth) tools enable real-time symptom tracking and automated alerts when symptom patterns change to allow timely, efficient, continuous care. We are testing a web-based mHealth platform designed to facilitate between visit symptom tracking, real-time data visualization by patients and providers, and automated data surveillance., Methods: Pediatric patients and/or parents of patients with inflammatory bowel disease (IBD) were offered access to an mHealth platform, called Orchestra, via a smart-phone based app that enabled personalized daily symptom tracking, journaling, and pre-visit planning including personalized summaries of their laboratory and clinical information prior to clinic visits. Tracked symptoms were monitored via automated data algorithms and statistical process control (SPC) rules, and values outside of either a pre-specified physiologic range or that showed a significant shift from a patient's baseline triggered an automated email alert to nurse and physician teams. The Orchestra platform and its integration into clinical workflow are being developed using PDSA (plan-do-study-act) quality improvement methodology., Results: To date, 22 IBD patients have been enrolled in the platform, with an average of 4.4 total symptoms tracked per patient (range 1 to 11) with tracker frequency ranging from daily to weekly. The most common symptoms being tracked are PROMIS Fatigue (n = 9), abdominal pain severity (n = 9), and custom measures tailored to patient (n = 9). Most enrolled patients (n = 10, 45%) are using the platform to receive the Pre-visit Plan and track a few (1-3) important symptoms. Patients have been enrolled on the platform for an average of 85 days (range 4 to 132). To date, 6 patients have triggered a symptom alert to the care team either by hitting a pre-specified threshold or a significant fluctuation in their data. Each of these alerts required earlier intervention/communication by the healthcare team than was outlined at the time of the last clinical encounter and resulted in change in medical care. None of the symptom changes that triggered the alerts were independently communicated by the family or patient to the medical team, but all were rated as medically relevant and actionable changes by the care team., Conclusions: The use of individualized patient symptom tracking in this pilot application has given us an introduction to the use of direct patient interaction in daily clinical care decisions. We anticipate that the use of individualized symptom tracking in testing of therapies will allow care teams and patients to share a common language when discussing response to treatments and may allow personalization of therapies and goals based on an individual's needs or values. We anticipate that the use of direct communication with the care team in a continuous fashion may also help establish the timing of visits (or type of visits) based on a patient's individual needs and physiology and lead to improved co-production of care., (C) Crohn's & Colitis Foundation of America, Inc.