Researchers have developed a mobile health index for remote monitoring of patients with inflammatory bowel diseases (IBD) that could be incorporated into a smartphone app. These findings are reported in the December issue of Clinical Gastroenterology and Hepatology.
The shift from symptom-oriented to prevention-oriented care delivery has accelerated the development of mobile health technologies and is transforming health care delivery. Smartphone adoption is increasing rapidly: 64% of Americans used smartphones in 2014, and of these, 62% used their telephones to look up health information. Many health apps are available—most provide health information or support data collection.
Apps are available for patients with IBD that track symptoms, record meal details, and manage medications. These apps can create reports for providers but do not allow for real-time interactions between patient and provider.
Patient-reported outcomes (PROs) are used to evaluate health status, and are being used in outcome measurement, symptom management, and now, healthcare apps. Welmoed K. Van Deen et al identified the most optimal PRO score for use in a disease-monitoring app for IBD.
The authors developed and validated a mobile health index for Crohn’s disease (CD) and ulcerative colitis (UC) that monitors disease activity, based on data from disease-specific questionnaires completed by 110 patients with CD and 109 with UC in California. PROs were compared with clinical disease activity index scores to identify factors associated with disease activity.
Van Deen et al assessed activity of CD based on liquid stool frequency, abdominal pain, patient well-being, and patient-assessed disease control, and activity of UC based on stool frequency, abdominal pain, rectal bleeding, and patient-assessed disease control.
Their indices identified clinical disease activity with area under the receiver operating characteristic curve values of 0.90 in patients with CD and 0.91 in patients with UC. The indices identified endoscopic activity with area under the receiver operating characteristic values of 0.63 in patients with CD and 0.82 in patients with UC.
Although previous studies aimed to identify PROs for disease monitoring, either by adjusting existing questionnaires or using subcomponents of existing questionnaires, Van Deen et al state that they were able to prospectively identify PROs relevant for clinical disease monitoring and validate those in an independent cohort.
Cloud-based health technologies are likely to revolutionize care delivery and patient engagement. The authors explain that patients can participate in their care by signaling meaningful health outcomes during year-round monitoring.
However, in an editorial that accompanies the article, Lawrence Kosinski and Joel V. Brill write that simply engaging patients with smart phones, wearable sensors, and telehealth will not simply improve health outcomes, avoid complications and unnecessary services, or decrease the cost of care. Kosinski and Brill state that health apps must be integrated with the provision of care.
Van Deen et al state that prospective, randomized studies are needed to assess the effect of remote monitoring on disease control, quality of life, patient satisfaction, and health care costs. Barriers to widespread implementation of mobile apps in IBD care include policies that affect reimbursement and regulatory requirements and privacy and security concerns.
In an article in the same issue, Muhammad Safwan Riaz and Ashish Atreja review remote monitoring strategies (mobile apps, telemedicine, and remote sensors), and whether these can alter outcomes and experiences of patients with chronic digestive disorders.