Mobile App Use for Diverse and Aging Populations: Transformative Potential for Clinical Practice

BACKGROUND The distribution of printed materials is the most frequently used strategy to disseminate and implement clinical practice guidelines, although several studies have shown that the effectiveness of this approach is modest at best. Nevertheless, there is insufficient evidence to support the use of other strategies. Recent research has shown that the use of computerized decision support presents a promising approach to address some aspects of this problem. OBJECTIVE The aim of this study is to provide qualitative evidence on the potential effect of mobile decision support systems to facilitate the implementation of evidence-based recommendations included in clinical practice guidelines. METHODS We will conduct a qualitative study with two arms to compare the experience of primary care physicians while they try to implement an evidence-based recommendation in their clinical practice. In the first arm, we will provide participants with a printout of the guideline article containing the recommendation, while in the second arm, we will provide participants with a mobile app developed after formalizing the recommendation text into a clinical algorithm. Data will be collected using semistructured and open interviews to explore aspects of behavioral change and technology acceptance involved in the implementation process. The analysis will be comprised of two phases. During the first phase, we will conduct a template analysis to identify barriers and facilitators in each scenario. Then, during the second phase, we will contrast the findings from each arm to propose hypotheses about the potential impact of the system. RESULTS We have formalized the narrative in the recommendation into a clinical algorithm and have developed a mobile app. Data collection is expected to occur during 2018, with the first phase of analysis running in parallel. The second phase is scheduled to conclude in July 2019. CONCLUSIONS Our study will further the understanding of the role of mobile decision support systems in the implementation of clinical practice guidelines. Furthermore, we will provide qualitative evidence to aid decisions made by low- and middle-income countries’ ministries of health about investments in these technologies.

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Planning Implementation Success of Syncope Clinical Practice Guidelines in the Emergency Department Using CFIR Framework

10.20944/preprints202103.0679.v1 ◽

2021 ◽

Author(s):

Jing Li ◽

Susan S. Smyth ◽

Jessica Miller Clouser ◽

Colleen A. McMullen ◽

Vedant Gupta ◽

...

Keyword(s):

Emergency Department ◽

Clinical Practice ◽

Family Caregivers ◽

Implementation Strategy ◽

Care Pathway ◽

Implementation Strategies ◽

Mobile App ◽

Care Plan ◽

Local Context ◽

Successful Implementation

Background and Objectives: Overuse and inappropriate use of testing and hospital admission are common in syncope evaluation and management. Though guidelines are available to optimize syncope care, study suggested that the current clinical guidelines have not significantly impacted resource utilization surrounding emergency department (ED) evaluation of syncope. Matching implementation strategies to barriers and facilitators and tailoring strategies to local context hold significant promise for a successful implementation of clinical practice guideline (CPG). Our team applied implementation science principles to develop a stakeholder-based implementation strategy. Methods and Materials: We partnered with patients, family caregivers, frontline clinicians and staff, and health system administrators at four health systems to conduct quantitative surveys and qualitative interviews for context assessment. The identification of implementation strategies was done by applying the CFIR-ERIC Implementation Strategy Matching Tool and soliciting stakeholders’ inputs. We then co-designed with patients and frontline teams, developed and tested specific strategies. Results: 114 clinicians completed surveys and 32 clinicians and stake-holders participated in interviews. Results from the surveys and interview indicated low awareness of syncope guidelines, and communication challenges with patients, lack of CPG protocol integration into ED workflows, and organizational process to change were recognized as major barriers. Thirty-one patients and their family caregivers participated in interviews and ex-pressed their expectations: clarity regarding their diagnosis, context surrounding care plan and diagnostic testing, and a desire to feel cared about. After identifying change methods to address those barriers, the multilevel, multicomponent implementation strategy, MISSION, included pa-tient educational materials, mentored implementation, academic detailing, Syncope Optimal Care Pathway and corresponding Mobile App, and Lean quality improvement methods. The pilot of MISSION demonstrated feasibility, acceptability and initial success on appropriate testing. Con-clusions: Effect multifaceted implementation strategies that target individuals, teams, and healthcare systems can be employed to plan successful implementation and promote adherence to syncope CPGs.

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Bariatric Surgery Decision-Making Calculator: A Novel Mobile App for Evidence-Based Clinical Practice

Surgery for Obesity and Related Diseases ◽

10.1016/j.soard.2017.09.323 ◽

2017 ◽

Vol 13 (10) ◽

pp. S147 ◽

Cited By ~ 2

Author(s):

Ali Aminian ◽

Stacey Clemence ◽

Jay Alberts ◽

Philip Schauer ◽

Stacy Brethauer

Keyword(s):

Bariatric Surgery ◽

Decision Making ◽

Clinical Practice ◽

Mobile App ◽

Evidence Based

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The Interactive Mobile App Review Toolkit (IMART): a Clinical Practice-Oriented System

Journal of Technology in Behavioral Science ◽

10.1007/s41347-016-0005-z ◽

2016 ◽

Vol 1 (1-4) ◽

pp. 3-15 ◽

Cited By ~ 9

Author(s):

Marlene M. Maheu ◽

Viola Nicolucci ◽

Myron L. Pulier ◽

Karen M. Wall ◽

Tami J. Frye ◽

...

Keyword(s):

Clinical Practice ◽

Mobile App ◽

Oriented System

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A Mobile Technology for Collecting Patient-Reported Physical Activity and Distress Outcomes: Cross-Sectional Cohort Study

JMIR mhealth and uhealth ◽

10.2196/17320 ◽

2020 ◽

Vol 8 (5) ◽

pp. e17320

Author(s):

Miyeon Jung ◽

SaeByul Lee ◽

Jisun Kim ◽

HeeJeong Kim ◽

BeomSeok Ko ◽

...

Keyword(s):

Physical Activity ◽

Clinical Practice ◽

Mobile App ◽

Assessment Tools ◽

Patient Health Questionnaire ◽

Time Interval ◽

Health Questionnaire ◽

Patient Reported ◽

Patient Health ◽

Paper And Pencil

Background Electronic patient-reported outcome (PROs) provides a fast and reliable assessment of a patient’s health-related quality of life. Nevertheless, using PRO in the traditional paper format is not practical for clinical practice due to the limitations associated with data analysis and management. A questionnaire app was developed to address the need for a practical way to group and use distress and physical activity assessment tools. Objective The purpose of this study was to assess the level of agreement between electronic (mobile) and paper-and-pencil questionnaire responses. Methods We validated the app version of the distress thermometer (DT), International Physical Activity Questionnaire (IPAQ), and Patient Health Questionnaire–9 (PHQ-9). A total of 102 participants answered the paper and app versions of the DT and IPAQ, and 96 people completed the PHQ-9. The study outcomes were the correlation of the data between the paper-and-pencil and app versions. Results A total of 106 consecutive breast cancer patients were enrolled and analyzed for validation of paper and electronic (app) versions. The Spearman correlation values of paper and app surveys for patients who responded to the DT questionnaire within 7 days, within 3 days, and on the same day were .415 (P<.001), .437 (P<.001), and .603 (P<.001), respectively. Similarly, the paper and app survey correlation values of the IPAQ total physical activity metabolic equivalent of task (MET; Q2-6) were .291 (P=.003), .324 (P=.005), and .427 (P=.01), respectively. The correlation of the sum of the Patient Health Questionnaire–9 (Q1-9) according to the time interval between the paper-based questionnaire and the app-based questionnaire was .469 for 14 days (P<.001), .574 for 7 days (P<.001), .593 for 3 days (P<.001), and .512 for the same day (P=.03). These were all statistically significant. Similarly, the correlation of the PHQ (Q10) value according to the time interval between the paper-based questionnaire and the app-based questionnaire was .283 for 14 days (P=.005), .409 for 7 days (P=.001), .415 for 3 days (P=.009), and .736 for the same day (P=.001). These were all statistically significant. In the overall trend, the shorter the interval between the paper-and-pencil questionnaire and the app-based questionnaire, the higher the correlation value. Conclusions The app version of the distress and physical activity questionnaires has shown validity and a high level of association with the paper-based DT, IPAQ (Q2-6), and PHQ-9. The app-based questionnaires were not inferior to their respective paper versions and confirm the feasibility for their use in clinical practice. The high correlation between paper and mobile app data allows the use of new mobile apps to benefit the overall health care system. Trial Registration ClinicalTrials.gov NCT03072966; https://clinicaltrials.gov/ct2/show/NCT03072966

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Assessment of mHealth Solutions Applied to Fall Detection for the Elderly

10.3233/shti210606 ◽

2021 ◽

Author(s):

Fellipe Soares de Oliveira ◽

Camila Carvalho da Silva ◽

Talita Santos Pinheiro ◽

Larissa Mayumi Yokoi ◽

Pablo Deoclecia dos Santos ◽

...

Keyword(s):

Clinical Practice ◽

Mobile Health ◽

Rating Scale ◽

Fall Detection ◽

The Elderly ◽

Mobile App ◽

Assessment Methods ◽

Rigorous Evaluation ◽

Wide Availability

Mobile Health has been increasingly present in healthcare due to the wide availability of applications for smartphones, however, robust assessment methods must be considered, seeking to provide evidence for clinical practice and mHealth solutions. This research presents the assessment of applications aimed at detecting and preventing falls for the elderly, available for Android and IOS, through the Mobile App Rating Scale. Based on the results presented, it can be concluded that the fall detection and prevention applications for the elderly available for Android and IOS showed good quality after rigorous evaluation.

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Enhanced recovery after surgery (ERAS) pathway for primary hip and knee arthroplasty: study protocol for a randomized controlled trial

Trials ◽

10.1186/s13063-019-3706-8 ◽

2019 ◽

Vol 20 (1) ◽

Cited By ~ 1

Author(s):

Jingyi Li ◽

Haibei Zhu ◽

Ren Liao

Keyword(s):

Randomized Controlled Trial ◽

Clinical Practice ◽

Knee Arthroplasty ◽

Enhanced Recovery ◽

Enhanced Recovery After Surgery ◽

Controlled Trial ◽

Early Mobilization ◽

Quality Of Healthcare ◽

Randomized Controlled ◽

Aging Populations

Abstract Background With the substantially growing trend of the aging populations in China and the rest of the world, the number of total hip and total knee arthroplasty (THA and TKA) cases are increasing dramatically. It is important to develop practical strategies to improve the quality of healthcare and better outcome for patients undergoing THA and TKA. Enhanced recovery after surgery (ERAS) pathways have been reported to promote earlier recovery and be beneficial for patients. We propose the hypothesis that the ERAS pathway could reduce the length of stay (LOS) in hospital for patients undergoing primary THA or TKA. Methods/Design This trial is a prospective, open-labelled, multi-centered, randomized controlled trial that will test the superiority of the ERAS pathway in term of LOS in hospital for the patients undergoing primary THA or TKA compared to current non-ERAS clinical practice. A total of 640 patients undergoing primary THA or TKA will be randomly allocated to either ERAS pathway (ERAS group) or conventional care according to individual participating center (non-ERAS group). The primary outcome is the total LOS in hospital; the secondary outcomes include postoperative LOS, all-cause mortality by 30 days after operation, in-hospital complications, early mobilization, postoperative pain control, total in-hospital cost, and readmission rate by 30 days after discharge from the hospital. Discussion This trial is designed to evaluate the superiority of the ERAS pathway to conventional non-ERAS clinical practice in reducing the LOS. The results may provide new insight into the clinical applications of the ERAS pathway for THA and TKA. Trial registration National Institutes of Health Clinical Trials Registry, NCT03517098. Registered on 4 May 2018.

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Iphone app use to Cobb angle in adolescent idiopathic scoliosis: Does this apply?

Coluna/Columna ◽

10.1590/s1808-185120151402145324 ◽

2015 ◽

Vol 14 (2) ◽

pp. 101-104 ◽

Cited By ~ 3

Author(s):

Antenor Rafael de Oliveira Mazzuia ◽

Diógenes Rodrigues Machado ◽

Denis Kiyoshi Fukumothi ◽

Luccas Franco Bettencourt Nunes ◽

Carlos Tucci Neto ◽

...

Keyword(s):

Clinical Practice ◽

Standard Deviation ◽

Adolescent Idiopathic Scoliosis ◽

Confidence Interval ◽

Idiopathic Scoliosis ◽

Cobb Angle ◽

Traditional Method ◽

Mobile App ◽

Radiographic Measurements ◽

The Mean

<sec><title>OBJECTIVE:</title> To validate a new method of measuring the Cobb angle for scoliosis from the mobile app CobbMeter to facilitate the evaluation and measurement in clinical practice.</sec><sec><title>METHODS:</title> Five observers with minimum experience of two years in the field performed radiographic measurements of Cobb angle in 24 radiographs of patients with adolescent idiopathic scoliosis through the CobbMeter. Observers performed serial measures on the images with the application, which were repeated after one month. The most experienced appraiser of the group, after measurements were made through the application, determined the Cobb angle in each radiography by the traditional method.</sec><sec><title>RESULTS:</title> The mean standard deviation by comparing the angles electronically and manually measured had no clinical significance. Although 40% of electronic measurements are outside the confidence interval when compared to manual measurements, this difference was insignificant in clinical practice.</sec><sec><title>CONCLUSIONS:</title> The CobbMeter is another alternative for measuring Cobb angle in scoliosis.</sec>

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The Effects of Continuous Usage of Diabetes Management App on Glycemic Control in Real-world Clinical Practice: Retrospective Analysis (Preprint)

10.2196/preprints.23227 ◽

2020 ◽

Author(s):

Yu-Zhen Tu ◽

Ya-Ting Chang ◽

Hung-Yi Chiou ◽

Ken Lai

Keyword(s):

Clinical Practice ◽

Glycemic Control ◽

Real World ◽

Mixed Model ◽

Diabetes Management ◽

Mobile App ◽

Bonferroni Correction ◽

Retention Group ◽

Level Of Use ◽

One Year

BACKGROUND The efficacy of digital technology in improving diabetes management has typically been demonstrated through studies based on randomized controlled trials (RCTs), showing steeper decrease of hemoglobin A1c (HbA1c) values for patients who adopted a digital solution. However, evidence from real-world clinical practice is still limited. OBJECTIVE To evaluate the effectiveness of digital interventions by tracking HbA1c improvement over one year in real-world clinical settings. METHODS The Health2Sync mobile app was used by patients to track self-measured outcomes and communicate with health care professionals (HCPs). The web-based Patient Management Platform was used by HCPs to monitor patient data, view test results from clinical labs, and communicate with patients. Patients that have been onboarded for at least 13 months and had consecutive HbA1c results for five quarters were included in the analysis. They were then stratified into three groups (high, mid, and low retention) according to their level of use of the mobile app in the first six months after onboarding. A mixed model was built to compare the slopes of HbA1c percentage decreases between the groups. In addition, these patients’ stickiness on the app from the seventh to the twelfth month was verified with multiple comparisons. RESULTS A sample of 2036 users was included in the analysis. With the mixed model coefficient estimates, we found that app users had significant HbA1c percentage decreases as the passed quarter count increased (t = -9.869, P < .001), and that effectiveness was enlarged in high and mid retention groups as the interaction effects were significantly negative compared with the low retention group (t = -6.620, P < .001 for passed quarter count * mid retention; t = -5.173, P < .001 for passed quarter count * high retention). The low retention group also had the highest average HbA1c value in the end of the 13 months [mean (SD): 7.01 (1.02) %, 6.99 (1.00) %, and 7.17 (1.14) % for high, mid, and low retention groups, respectively, P = .07, .02, and 1.00 for high-low, mid-low, and high-mid difference comparison after Bonferroni correction]. The level of use of the app remained consistent in the seventh to the twelfth month after onboarding [mean (SD): 5.23 (1.37) months, 2.43 (1.68) months, and 0.41 (0.97) months for high, mid, and low retention groups, respectively, P < .001 for all comparison pairs after Bonferroni correction]. CONCLUSIONS Our analysis showed that continuous usage of the diabetes management app is associated with better glycemic control in real-world clinical practice. Further studies can be performed to reveal the efficacy for specific diabetes types and to observe the effects beyond one year.

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