Methods / Measures: Patients were enrolled from September 2014 to November 2017 during routine asthma care in specialty and primary care clinics. Inclusion criteria included provider diagnosis of asthma, prescription for SABA, Spanish or English fluency, and absence of other pulmonary disease or significant co-morbidity. Patients were prescribed medications according to standard guideline practice. Those who enrolled in a prior EMM clinical trial at Dignity Health were excluded. Patients were provided digital EMMs (Propeller Health, Madison, WI) that attached to both controller and SABA inhaled medication(s). EMMs recorded date, time and number of puffs taken. The EMMs are part of a Food and Drug Administration (FDA) 510(k) cleared digital health platform consisting of mobile applications, web-based dashboards, and communication channels such as text messaging and email. Patients authorized their HCPs to view their reports through a web interface, enabling them to integrate real-time information on SABA use and controller adherence into clinical decision-making. Healthcare utilization information was collected from Dignity Health claims data for hospitalizations, emergency department (ED) visits and outpatient visits. These events were identified as asthma-related when specific codes (ICD9 493.XX or ICD10 J45.XX) were present in the primary billing position. Rate differences and their 95% confidence intervals were estimated to assess the change in pre-post utilization for ED visits, hospitalizations, combined ED visits plus hospitalizations, and outpatient visits, and p-values were calculated using Wilcoxon signed rank tests. For patients prescribed both SABA and controller medications, the controller-to-total medication ratio, defined as the number of controller medication puffs recorded divided by the total number of puffs of SABA plus controller medications, was calculated. Patients were observed for 365 data days pre- and post-enrollment.
Results: Participants (n = 224) were 57% female with a mean age of 33 years (Table 1). Asthma-related healthcare utilization data are reported for the pre- and post-enrollment years (Table 2; Fig. 1). From the pre- to post-enrollment year, asthma-related hospitalizations, ED visits, and combined ED and hospitalization events declined by 1.3 (95% CI, − 0.6, 3.3, p = 0.23), 6.0 (95% CI, 0.9, 11.6, p = 0.04), and 7.6 (95% CI, 1.9, 13.3, p = 0.02) events per 100 patient-years, respectively. Outpatient visits per patient for asthma increased by 2.6 (95% CI, 2.2, 2.9) visits per patient-year (p < 0.01).
Conclusions: This analysis demonstrated that digital health interventions can be incorporated into routine clinical practice, and their use may contribute to improved outcomes including reduced healthcare utilization and reduced SABA use. The information collected by the EMMs, and shared with both patients and HCPs, can promote self-management and support personalized clinical care to achieve better asthma outcomes.
DOI: https://linkinghub.elsevier.com/retrieve/pii/S1939455118301868
