Jorge Sulca Flores

Pronouns

He/Him/His

Job Title

Clinical Research Assistant

Academic Rank

Department

Medicine

Authors

Jorge A. Sulca Flores, Robert S. Rudin, PhD, Dinah Foer, MD, Savanna Plombon, Jessica Sousa, Jorge Rodriguez, MD, Anuj K. Dalal, MD,

Principal Investigator

Dr. Anuj Dalal

Research Category: Lung Research

Tags

Analysis of Call-Back Requests for an ePRO Asthma Symptom Monitoring App Integrated into Primary Care

Scientific Abstract

We developed an mHealth app to help asthma patients monitor their symptoms between clinic visits using electronic patient reported outcomes (ePROs). Patients using the mHealth app are prompted to request a call from a nurse when their asthma symptoms become problematic, defined as severe, substantially worse compared to baseline, or substantially worse compared to previous week based on responses to the ePRO questionnaire. A triage nurse is notified via an “inbasket” message in the electronic health record (EHR) when the patient requests a call-back via the app. As part of an ongoing randomized control trial, we analyzed call-back requests to assess whether downstream actions documented in the EHR were related to asthma or indicative of meaningful therapeutic intervention. Of 20 call-back requests, the triage discussed symptoms in 14 (70%). Follow-up encounters occurred within 5.75 (7.0) calendar days after 16 (80%) call back requests. The 16 follow-up encounters had the following visit types: 7 (43.8%) telemedicine, 6 (37.5%) in person, 2 (12.5%) patient portal message, and 1 (6.3%) telephone. Asthma or cardinal asthma symptoms were coded as primary or secondary diagnosis in 13 (81.3%) and 3 (18.7%) of the follow-up encounters, respectively. Asthma medications were altered after 9 follow-up encounters (56.3%).

Lay Abstract

We developed an app to help patients monitor their asthma symptoms between clinic visits. First, patients answer a baseline questionnaire, then they answer a questionnaire on a weekly basis which is scored and compared to their baseline score. When their asthma symptoms become problematic, defined as severe, substantially worse compared to baseline, or substantially worse compared to previous week, then the patient has the option to request a call via the app. A triage nurse is notified via a message in the electronic health record (HER) and call the patient to follow up on their symptoms and offer appointments. As part of an ongoing randomized control trial, we analyzed such call-back requests to understand if the following actions were related to asthma. Of 20 call-back requests, the nurse triage discussed symptoms in 14 (70%). Follow-up encounters occurred within 5.75 (7.0) calendar days after 16 (80%) call back requests. The 16 follow-up encounters had the following visit types: 7 (43.8%) telemedicine, 6 (37.5%) in person, 2 (12.5%) patient portal message, and 1 (6.3%) telephone. Asthma was the primary or secondary diagnosis in 13 (81.3%) and 3 (18.7%) of the follow-up encounters, respectively. Asthma medications were altered after 9 follow-up encounters (56.3%).

Clinical Implications

Similar symptom monitoring interventions, including patient-requested call-back functionality could be implemented for other types of health conditions, thereby prompting more timely and pertinent therapeutic intervention during a chronic disease exacerbation.