Development of a Smartphone App for Regional Care Coordination Among High-Risk, Low-Income Patients

Liss, David T.; Brown, Tiffany; Wakeman, Julie; Dunn, Shira; Cesan, Ana; Guzmán, Adriana; Desai, Amish; Buchanan, David

doi:10.1089/tmj.2019.0176

Cited by 7 publications

(7 citation statements)

References 21 publications

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“…The geofence notifications aligned with objective HIE use data only 18.8% of the time, indicating that the community health paramedics were unable to connect with participants to provide follow-up assistance with care coordination after most participant ED and hospital visits. This finding was surprising given recent evidence that a smartphone app used by 12 patients with low income had 75% accuracy in detecting real-time ED or hospital use over a 3-month period [ 36 ]. It is likely that the results of this study are inconsistent with this prior evidence because of variations in the real-world use of smartphones among a population without consistent access to electricity.…”

Section: Discussionmentioning

confidence: 94%

GPS Mobile Health Intervention Among People Experiencing Homelessness: Pre-Post Study

Moczygemba¹,

Thurman²,

Tormey³

et al. 2021

JMIR Mhealth Uhealth

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Background People experiencing homelessness are at risk for gaps in care after an emergency department (ED) or hospital visit, which leads to increased use, poor health outcomes, and high health care costs. Most people experiencing homelessness have a mobile phone of some type, which makes mobile health (mHealth) interventions a feasible way to connect a person experiencing homelessness with providers. Objective This study aims to investigate the accuracy, acceptability, and preliminary outcomes of a GPS-enabled mHealth (GPS-mHealth) intervention designed to alert community health paramedics when people experiencing homelessness are in the ED or hospital. Methods This study was a pre-post design with baseline and 4-month postenrollment assessments. People experiencing homelessness, taking at least 2 medications for chronic conditions, scoring at least 10 on the Patient Health Questionnaire-9, and having at least 2 ED or hospital visits in the previous 6 months were eligible. Participants were issued a study smartphone with a GPS app programmed to alert a community health paramedic when a participant entered an ED or hospital. For each alert, community health paramedics followed up via telephone to assess care coordination needs. Participants also received a daily email to assess medication adherence. GPS alerts were compared with ED and hospital data from the local health information exchange (HIE) to assess accuracy. Paired t tests compared scores on the Patient Health Questionnaire-9, Medical Outcomes Study Social Support Survey, and Adherence Starts with Knowledge-12 adherence survey at baseline and exit. Semistructured exit interviews examined the perceptions and benefits of the intervention. Results In total, 30 participants were enrolled; the mean age was 44.1 (SD 9.7) years. Most participants were male (20/30, 67%), White (17/30, 57%), and not working (19/30, 63%). Only 19% (3/16) of the ED or hospital visit alerts aligned with HIE data, mainly because of patients not having the smartphone with them during the visit, the smartphone being off, and gaps in GPS technology. There was a significant difference in depressive symptoms between baseline (mean 16.9, SD 5.8) and exit (mean 12.7, SD 8.2; t19=2.9; P=.009) and a significant difference in adherence barriers between baseline (mean 2.4, SD 1.4) and exit (mean 1.5, SD 1.5; t17=2.47; P=.03). Participants agreed that the app was easy to use (mean 4.4/5, SD 1.0, with 5=strongly agree), and the email helped them remember to take their medications (mean 4.6/5, SD 0.6). Qualitative data indicated that unlimited smartphone access allowed participants to meet social needs and maintain contact with case managers, health care providers, family, and friends. Conclusions mHealth interventions are acceptable to people experiencing homelessness. HIE data provided more accurate ED and hospital visit information; however, unlimited access to reliable communication provided benefits to participants beyond the study purpose of improving care coordination.

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Section: Discussionmentioning

confidence: 94%

GPS Mobile Health Intervention Among People Experiencing Homelessness: Pre-Post Study

Moczygemba¹,

Thurman²,

Tormey³

et al. 2021

JMIR Mhealth Uhealth

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“…There were high rates of chronic illness, with 59.7% having two or more illnesses. As observed previously (18), participants received several alerts (i.e., push notifications) from the app during study follow-up. Many of these alerts (82.5%) were ultimately deemed 'false positives' due to reasons such as being near the hospital (within a hospital geofence) for 45 minutes or longer, or visiting a hospitalized loved one.…”

Section: Resultsmentioning

confidence: 99%

“…As part of a larger study to evaluate this care coordination intervention (18), we recruited patients from an urban federally qualified health center (FQHC) in the Midwest.…”

Section: Study Participants and Settingmentioning

confidence: 99%

“…Information on the design of the ER Alert app, and incorporation of the app within a regional care coordination intervention is detailed elsewhere (18), but outlined briefly here. We conducted interviews with patients, clinicians, and care managers about app acceptance and integration into the FQHC clinical workflows (17), which gave us valuable insight on how to integrate the app into the health practice in reality.…”

Section: App Workflowmentioning

confidence: 99%

“…In collaboration with patients, our team developed a smartphone app to facilitate real-time care coordination during ED and inpatient visits, and immediately after discharge. After initial testing of the first app version (17), we updated the location tracking algorithm and app user interface for the second generation under study here (18). The goal of this study was to understand how traditionally underserved and vulnerable patients felt about the app after four months of use on their personal phone.…”

Section: Introductionmentioning

confidence: 99%

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“It closes the gap when the ball is dropped”: patient perspectives of a novel smartphone app for regional care coordination after hospital encounters

Guzmán¹,

Brown²,

Liss³

2022

mHealth

Self Cite

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Background: Despite the broad adoption of electronic health records (EHRs) for inpatient and outpatient care, and wide availability of EHR-linked portals, these tools are not always effective in informing primary care teams about patients' emergency department (ED) visits or inpatient admissions, leading to persistent gaps in care coordination. The objective of this study was to understand how patients with limited patient portal use in a safety net setting engaged with a smartphone app that used location tracking to detect and notify care teams about patients' hospital use in order to stimulate care coordination and follow-up care.Methods: We recruited English-and Spanish-speaking adults at high risk of hospital use from a Federally Qualified Health Center (FQHC). The app detected when patients visited the hospital and asked them to confirm a hospital visit. When confirmed, the app notified the primary care team about the visit, and the care team followed up with patients according to the FQHC protocols for care coordination. We collected qualitative data on app experience from participants who used the app for four months and used a general inductive approach to identify recurring themes.Results: Participants generally reported a positive app experience, as it helped solve the problem of poor follow-up care. "I liked the goal of the app…Ultimate goal of it was comforting", recounted one participant when describing her app experience. Participants thought the app push notifications could be refined and the app itself could be modernized. Participants also suggested improvements to the push notifications they received from the app and the visit information they entered into the app for care teams to receive. Some participants also suggested improvements to the FQHC's care coordination workflows facilitated by the app, like an immediate connection to the patient's primary care team. Conclusions:The app was well received by low-income patients at high risk of ED/inpatient visits. Future research is needed to determine feasibility of implementation in other settings.

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Enhancing communication and care coordination: A scoping review of encounter notification systems between emergency departments and primary care providers

Joseph,

Tomaschek,

Hug

et al. 2024

International Journal of Medical Informatics

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Development of a Smartphone App for Regional Care Coordination Among High-Risk, Low-Income Patients

Cited by 7 publications

References 21 publications

GPS Mobile Health Intervention Among People Experiencing Homelessness: Pre-Post Study

GPS Mobile Health Intervention Among People Experiencing Homelessness: Pre-Post Study

“It closes the gap when the ball is dropped”: patient perspectives of a novel smartphone app for regional care coordination after hospital encounters

Enhancing communication and care coordination: A scoping review of encounter notification systems between emergency departments and primary care providers

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