A Smart Mobile Health Tool Versus a Paper Action Plan to Support Self-Management of Chronic Obstructive Pulmonary Disease Exacerbations: Randomized Controlled Trial

Background Many patients with chronic obstructive pulmonary disease (COPD) suffer from exacerbations, a worsening of their respiratory symptoms that warrants medical treatment. Exacerbations are often poorly recognized or managed by patients, leading to increased disease burden and health care costs. Objective This study aimed to examine the effects of a smart mobile health (mHealth) tool that supports COPD patients in the self-management of exacerbations by providing predictions of early exacerbation onset and timely treatment advice without the interference of health care professionals. Methods In a multicenter, 2-arm randomized controlled trial with 12-months follow-up, patients with COPD used the smart mHealth tool (intervention group) or a paper action plan (control group) when they experienced worsening of respiratory symptoms. For our primary outcome exacerbation-free time, expressed as weeks without exacerbation, we used an automated telephone questionnaire system to measure weekly respiratory symptoms and treatment actions. Secondary outcomes were health status, self-efficacy, self-management behavior, health care utilization, and usability. For our analyses, we used negative binomial regression, multilevel logistic regression, and generalized estimating equation regression models. Results Of the 87 patients with COPD recruited from primary and secondary care centers, 43 were randomized to the intervention group. We found no statistically significant differences between the intervention group and the control group in exacerbation-free weeks (mean 30.6, SD 13.3 vs mean 28.0, SD 14.8 weeks, respectively; rate ratio 1.21; 95% CI 0.77-1.91) or in health status, self-efficacy, self-management behavior, and health care utilization. Patients using the mHealth tool valued it as a more supportive tool than patients using the paper action plan. Patients considered the usability of the mHealth tool as good. Conclusions This study did not show beneficial effects of a smart mHealth tool on exacerbation-free time, health status, self-efficacy, self-management behavior, and health care utilization in patients with COPD compared with the use of a paper action plan. Participants were positive about the supportive function and the usability of the mHealth tool. mHealth may be a valuable alternative for COPD patients who prefer a digital tool instead of a paper action plan. Trial Registration ClinicalTrials.gov NCT02553096; https://clinicaltrials.gov/ct2/show/NCT02553096.

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A Meta-Analysis of Health Status, Health Behaviors, and Health Care Utilization Outcomes of the Chronic Disease Self-Management Program

Preventing Chronic Disease ◽

10.5888/pcd10.120112 ◽

2013 ◽

Vol 10 ◽

Cited By ~ 134

Author(s):

Teresa J. Brady ◽

Louise Murphy ◽

Benita J. O’Colmain ◽

Danielle Beauchesne ◽

Brandy Daniels ◽

...

Keyword(s):

Health Care ◽

Chronic Disease ◽

Health Status ◽

Health Care Utilization ◽

Health Behaviors ◽

Meta Analysis ◽

Management Program ◽

Self Management ◽

Care Utilization

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Improving Self-Management Skills Among People With Spinal Cord Injury: Protocol for a Mixed-Methods Study (Preprint)

10.2196/preprints.11069 ◽

2018 ◽

Author(s):

W Ben Mortenson ◽

Patricia Branco Mills ◽

Jared Adams ◽

Gurkaran Singh ◽

Megan MacGillivray ◽

...

Keyword(s):

Health Care ◽

Spinal Cord ◽

Spinal Cord Injury ◽

Health Care Utilization ◽

Self Efficacy ◽

Self Management ◽

Care Utilization ◽

Management Skills ◽

Secondary Complications ◽

Cord Injury

BACKGROUND Most people with spinal cord injury will develop secondary complications with potentially devastating consequences. Self-management is a key prevention strategy for averting the development of secondary complications and their recurrence. Several studies have shown that self-management programs improve self-management behaviors and health outcomes in individuals living with chronic conditions such as asthma, diabetes, hypertension, and arthritis. Given the burgeoning health care costs related to secondary complications, we developed an alternative electronic health–based implementation to facilitate the development of self-management skills among people with spinal cord injury. OBJECTIVE This study aims to evaluate the efficacy of a self-management app in spinal cord injury populations. The primary outcome is attainment of self-selected, self-management goals. Secondary outcomes include increases in general and self-management self-efficacy and reductions in self-reported health events, health care utilization, and secondary complications related to spinal cord injury. This study also aims to explore how the intervention was implemented and how the app was experienced by end users. METHODS This study will employ a mix of qualitative and quantitative methods. The quantitative portion of our study will involve a rater-blinded, randomized controlled trial with a stepped wedge design (ie, delayed intervention control group). The primary outcome is successful goal attainment, and secondary outcomes include increases in self-efficacy and reductions in self-reported health events, health care utilization, and secondary conditions related to spinal cord injury. The qualitative portion will consist of semistructured interviews with a subsample of the participants. RESULTS We expect that the mobile self-management app will help people with spinal cord injury to attain their self-management goals, improve their self-efficacy, reduce secondary complications, and decrease health care utilization. CONCLUSIONS If the results are positive, this study will produce credible new knowledge describing multiple outcomes that people with spinal cord injury realize from an app-based self-management intervention and support its implementation in clinical practice. CLINICALTRIAL ClinicalTrials.gov NCT03140501; http://clinicaltrials.gov/ct2/show/NCT03140501 (Archived by WebCite at http://www.webcitation.org/73Gw0ZlWZ) INTERNATIONAL REGISTERED REPOR PRR1-10.2196/11069

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FRI0629-HPR USE AND USABILITY OF THE DR. BART APP AND ITS RELATION WITH CLINICAL OUTCOMES IN PEOPLE WITH KNEE AND/OR HIP OSTEOARTHRITIS

Annals of the Rheumatic Diseases ◽

10.1136/annrheumdis-2020-eular.1299 ◽

2020 ◽

Vol 79 (Suppl 1) ◽

pp. 919.1-919

Author(s):

T. Pelle ◽

J. Van der Palen ◽

F. Van den Hoogen ◽

K. Bevers ◽

C. Van den Ende

Keyword(s):

Health Care ◽

Health Care Utilization ◽

Clinical Outcomes ◽

Intervention Group ◽

Central Element ◽

Hip Osteoarthritis ◽

Theoretical Framework ◽

Self Management ◽

Care Utilization ◽

Considerable Proportion

Background:Self-management is of paramount importance in non-surgical treatment of knee and/or hip osteoarthritis(OA). Modern technologies offer the possibility to support self-management 24/7. We developed an e-self-management application (dr. Bart app) for people with knee and/or hip OA.Objectives:To document the use of the dr. Bart app and its relation with health care utilization and clinical outcomes in people with knee and/or hip OA.Methods:For this study we used back end data of the first 26 weeks from the intervention group (N=214) of a RCT (total included 427) examining the effectiveness of the dr. Bart app. Participants were included based on self-reported knee and/or hip OA. In figure 1 the theoretical framework of the dr. Bart app is presented. A central element of the dr. Bart app is that the app proposes a selection of 72 preformulated goals for health behaviours based on the ‘tiny habits method’1(e.g. today I rise 12 times from my chair to train my leg muscles). The proposals are tailored to user characteristics and related to four themes that are core elements in the non-surgical management of OA. After a user completes one or more of the selected goals, a new selection is proposed by dr. Bart. A user can work on 3 goals simultaneously. Goals can be completed more than once by the same user. To assess the association between intensity of use of the app and health care utilization and clinical outcomes, we calculated Spearman rank correlation coefficients.Figure 1.Theoretical framework of the dr. Bart app.Results:171 / 214 participants (80 %) logged in at least once whilst 151 (71%) chose at least one goal and 114 (53 %) completed at least one goal during the 26 weeks. Of those who chose at least one goal, 56 participants (37 %) continued to log in up to 26 weeks, 12 (8 %) continued to select new goals from the offered goals and 37 (25 %) continued to complete goals (Figure 2). Preformulated goals regarding the themes activity (e.g. performing an exercise from the exercises library of the app) and nutrition (e.g. eat 2 pieces of fruit today) were found to be most popular by users. We found no correlations between intensity of use and health care utilization and clinical outcomes.Figure 2.Percentage of active users (N=151) over time.Conclusion:A considerable proportion of persons with knee and/or hip OA persistently used the app up to 26 weeks. Patients appear to have preferences for goals related to activity and nutrition, rather than for goals related to vitality and education. We found no relation between intensity of use of the dr. Bart app and health care utilization and clinical outcomes.References:[1] Fogg GJ: A behavior model for persuasive design. In: Proceedings of the 4thinternational Conference on Persuasive Technology: 2009: ACM; 2009: 40.Disclosure of Interests:None declared

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Self-reported health status is a strong predictor of health care utilization

PsycEXTRA Dataset ◽

10.1037/e556952006-013 ◽

1999 ◽

Keyword(s):

Health Care ◽

Health Status ◽

Health Care Utilization ◽

Strong Predictor ◽

Care Utilization ◽

Reported Health ◽

Self Reported Health Status

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Health status and health care utilization after discharge from geriatric in-hospital stay – description of a register-based study

BMC Health Services Research ◽

10.1186/s12913-021-06751-3 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

E. Rydwik ◽

R. Lindqvist ◽

C. Willers ◽

L. Carlsson ◽

G. H. Nilsson ◽

...

Keyword(s):

Primary Care ◽

Health Care ◽

Health Status ◽

Health Care Utilization ◽

Care Utilization ◽

Future Studies ◽

Healthcare Data ◽

Utilization Data ◽

Hospital Stays ◽

Socioeconomic Data

Abstract Background This study is the first part of a register-based research program with the overall aim to increase the knowledge of the health status among geriatric patients and to identify risk factors for readmission in this population. The aim of this study was two-fold: 1) to evaluate the validity of the study cohorts in terms of health care utilization in relation to regional cohorts; 2) to describe the study cohorts in terms of health status and health care utilization after discharge. Methods The project consist of two cohorts with data from patient records of geriatric in-hospital stays, health care utilization data from Stockholm Regional Healthcare Data Warehouse 6 months after discharge, socioeconomic data from Statistics Sweden. The 2012 cohort include 6710 patients and the 2016 cohort, 8091 patients; 64% are women, mean age is 84 (SD 8). Results Mean days to first visit in primary care was 12 (23) and 10 (19) in the 2012 and 2016 cohort, respectively. Readmissions to hospital was 38% in 2012 and 39% in 2016. The validity of the study cohorts was evaluated by comparing them with regional cohorts. The study cohorts were comparable in most cases but there were some significant differences between the study cohorts and the regional cohorts, especially regarding amount and type of primary care. Conclusion The study cohorts seem valid in terms of health care utilization compared to the regional cohorts regarding hospital care, but less so regarding primary care. This will be considered in the analyses and when interpreting data in future studies based on these study cohorts. Future studies will explore factors associated with health status and re-admissions in a population with multi-morbidity and disability.

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