A Mobile Health App Integrated in the Electronic Health Record for Rheumatoid Arthritis Patient Reported Outcomes: A Controlled Interrupted Time Series Analysis of Impact on Visit Efficiency
Daniel H. Solomon, Hallie Altwies, Leah Santacroce, Jack Ellrodt, Tammy Pham, Jacklyn Stratton, Adam Landman, Anuj Dalal, Jamie Collins, Robert S. Rudin- Immunology
- Rheumatology
- Immunology and Allergy
Background
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 app integrated in the electronic health record (EHR) can reduce visit volume for RA.
Methods
We developed an app for RA that prompted patients every other day to complete brief PRO questionnaires. Results of the app were integrated into the EHR. We tested the app in a controlled interrupted time‐series between 2020‐2023. Rheumatologists received EHR‐based messages based on PRO results recommending the patient receive a visit earlier or later than scheduled. Primary outcome was monthly visit volume during year before vs year after initiation.
Results
150 RA patients consented and used the app. 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 the app cohort, estimated monthly visit volume in the year prior to use of the app: 31.2 (95% CI 28.0‐34.3); in controls, this was 30.4 (27.3‐33.6). In year using the app, the estimated monthly visit volume 36.8 (33.4‐40.3) compared to 38.7 (35.2‐42.3) in controls. The difference in the differences between the cohorts was not statistically significant (‐2.7 visits, 95% CI –9.3‐4.0). No differences were noted in flare rates or visit delays.
Conclusions
In this initial trial of a PRO app intervention to improve visit efficiency, we found no association with reduced visit volume.