Background: Mobile health applications have the potential to support patients via improved engagement and self-management. While the use of this technology has been developed for patients with chronic diseases, there is limited evidence to guide the development of this technology for patients with acute conditions. Patients diagnosed with acute venous thromboembolic disease (VTE) are at high risk for complications during post-discharge transitions of care (TOC). We developed a novel VTE TOC bundle that integrates mobile health technology into existing post-discharge care management strategies. Here we present an interim analysis of engagement with mobile health technology among our acutely ill study participants.
Methods: An iOS/Android app with secure messaging with a Patient Navigator (a social worker focused on care transitions), daily text message (SMS) medication reminders, and VTE patient education materials were developed. We analyzed rates of app utilization by age, gender, risk of readmission (by the validated HOSPITAL Score), and insurance status. We conducted two focus groups of study participants who had completed the three month intervention to explore benefits and barriers to app use.
Results: At the interim analysis, 90 patients were enrolled in the study; 33 (37%) downloaded the app. Younger patients were statistically more likely to download the app (p < 0.01) and use the SMS reminders (p < 0.05; Table 1). Among the 33 patients who downloaded the app, younger patients were more likely to use the secure messaging (60% among 20-40 year olds vs 18% among 61-80 year olds). There was a trend for low risk patients to be more likely to download the app (46% vs 27%, p=0.07) and use the SMS reminders compared to intermediate/high risk patients (35% vs 18%, p=0.07) . There was no statistical relationship between gender or insurance status and app utilization (Table 1). The findings from the focus groups are presented in Table 2.
Conclusions: Mobile health technology use was low among patients with acute VTE. Older age was correlated with low utilization. Medical risk (as identified by the HOSPITAL Readmission Score) may reduce rates of app use, which has important implications for the application of such technology in acutely ill populations. Focus group responses indicated that some participants used alternative health technologies to replace functions of our app, such as other more customizable apps. Patients who used the app reported improved access to education, better communication, and higher levels of engagement. Our findings suggest that mobile health technology has the potential to improve TOC among acutely ill, high-risk populations, though the demographic characteristics of these patient populations present significant obstacles.