Use of Mobile Technology To Improve Acute Care Utilization in Sickle Cell Disease (North Carolina)

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Summary:

Sickle cell disease (SCD) is a chronic illness associated with frequent medical complications and hospitalizations. Importantly, approximately 90 percent of acute care visits are for pain events, and 30-day revisit rates are high. While factors influencing these high re-utilization rates are poorly understood, close followup and continued titration of pain medications have been shown to decrease these rates. Despite the success of mobile phone-based interventions for other chronic diseases, application of this technology to SCD treatment has been limited.

This research tested whether use of the “SMART app” (Sickle cell Mobile Application to Record symptoms via Technology application), a recently developed self-monitoring and management service for SCD, improved acute care utilization, compliance to treatment plans, and followup appointments. SMART allowed daily remote monitoring of pain, co-symptoms, and bi-directional texting between patients and their providers.

The specific aims of the research were as follows:

  • Determine acute care utilization for patients given SMART versus usual care following treatment. 
  • Document compliance using SMART to the treatment plan specified by the provider team for medications and followup appointments. 

The research team conducted a pilot study that randomized 59 patients with SCD to receive standard care or to use the SMART app. As compared to standard care, patients using SMART had significantly less acute care utilization and were more likely to return for followup visits. Daily review of pain scores remotely provided the medical team with the ability to text specific patients believed to be at risk due to increasing pain. Medication compliance was found to be extremely difficult to assess. Despite being reminded to bring their pill bottles, patients consistently did not bring their medications. Furthermore, although patients used the SMART app to record symptoms, medications taken were much less often recorded. Future studies will leverage these findings with the goals of enhancing the SMART app to provide patients with improved access to care, better decision making by medical providers, and ultimately an improved quality of life.

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Use of Mobile Technology To Improve Acute Care Utilization in Sickle Cell Disease - Final Report

Citation:
Shah N. Use of Mobile Technology To Improve Acute Care Utilization in Sickle Cell Disease - Final Report. (Prepared by Duke University under Grant No. R21 HS023989). Rockville, MD: Agency for Healthcare Research and Quality, 2019. (PDF, 826.23 KB)

The findings and conclusions in this document are those of the author(s), who are responsible for its content, and do not necessarily represent the views of AHRQ. No statement in this report should be construed as an official position of AHRQ or of the U.S. Department of Health and Human Services.
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