Through IMAGINE’s partnership with Crohn’s and Colitis Canada, the PACE Health Services research projects (Telemedicine for IBD; HealthPROMISE Patient Monitoring App, Quality Indicators in IBD Care; and e-Clinical Care Pathways to reduce steroid use) continue to enhance healthcare delivery for IBD across key IBD Centres of Excellence in Canada. Of particular note this past year, the Patient Monitoring App Project was completed at McMaster University and results from the study were published online in the Journal of Medical Systems.
With the rapid rise of smart phones, electronic health (eHealth) monitoring platforms may be an important healthcare tool to provide patients with effective self-management strategies to complement outpatient care. HealthPromise involves the use of technologies that facilitate health-related communication between patients and health care providers. It also provides patients with a means of tracking their medical information, learning about their condition, and getting their questions answered.
HealthPROMISE was developed based on patient input and designed to promote patient participation. Its creation was guided by a study that found three parameters that characterized the needs of IBD patients. The investigators noted that patients complained of a lack of information dissemination by their providers, struggles with the social impacts of IBD, and called for a tool that facilitates symptom monitoring with physician feedback to patient input. Through the application, patients track their symptoms, medications, quality of life scores (measured by Short Inflammatory Bowel Disease Questionnaire (SIBDQ), quality of care scores (measured by IBD quality indicators developed by the Canadian Association of Gastroenterology), visits with physicians, emergency room (ER) visits, or hospitalizations. They can then access their personal data through an individual patient dashboard where they can view the details of their different ePRO domains and their longitudinal trends. Their physicians are also able to keep track of the data, suggest changes in lifestyle or treatment, or facilitate a clinic visit. Further, the application also permits the flagging of patients with suboptimal disease control, medication non-adherence, or extra-intestinal complications which may require further attention.
The purpose of this study was to investigate whether the use of an IBD digital health monitoring platform, HealthPROMISE, leads to better quality of care and improved health outcomes in IBD patients. IBD patients were recruited in gastroenterology clinics and asked to install the HealthPROMISE application onto their smartphones. Patient satisfaction, quality of care, quality of life, patient symptoms, and resource utilization metrics were collected throughout the study and sent directly to their healthcare teams. Patients with abnormal symptom/SIBDQ scores were flagged for their physicians to follow up. After one-year, patient outcome metrics were compared to baseline values. Overall, out of 59 patients enrolled in the study, 54% logged into the application at least once during the study period. The number of IBD-related ER visits/hospitalizations in the year of use compared to the prior year demonstrated a significant decrease from 25% of patients to 3%. Patients also reported an increase in their understanding of the nature/causes of their condition after using the application. This study demonstrated that digital health monitoring platforms may aid in reducing the number of ER visits and hospitalizations in IBD patients.