TABLE 1.
Self‐management studies
| Year | Author | Title | Objective | Study design | Population | HIT Component | User | Outcomes | Results |
|---|---|---|---|---|---|---|---|---|---|
| RCT | |||||||||
| 2020 | Druss et al. 70 | Randomized trial of a mobile personal health record for behavioral health homes | To evaluate whether a mobile personal health record application improves quality of medical care in behavioral health homes, which provide onsite primary medical care in mental health clinics. | Randomized control trial (RCT) of personal health record for behavioral health homes of patients with serious mental illness and one or more cardiometabolic risk factors across two behavioral health homes assigned to intervention or usual care and followed for 12 months (n = 311) | Patients with serious mental illness and one or more cardiometabolic risk factors across two behavioral health homes | PHR Mobile application: A secure mobile personal health record (mPHR), programmed using Sencha Touch, including key information about diagnoses, medications, and laboratory test values and allowed them to track health goals | Patients |
A chart‐derived composite measure of quality of cardiometabolic and preventive services |
At 1 year follow‐up, participants in the mPHR group sustained high quality of care (70% of indicated services at baseline and at 12‐month follow‐up), in contrast to a decreased in quality for the usual‐care group (71% at baseline and 67% at follow‐up), resulting in a statistically significant (p < 0.05). |
| 2018 | Walker et al. 71 | Telemonitoring in Chronic Obstructive Pulmonary Disease (CHROMED): a randomized clinical trial | To evaluate the efficacy of home monitoring of lung mechanics by the forced oscillation technique and cardiac parameters in older patients with chronic obstructive pulmonary disease (COPD) and comorbidities. | Multicenter RCT of Telemonitoring of Chronic Obstructive Pulmonary Disease in patients with Global Initiative for Chronic Obstructive Lung Disease grades II to IV COPD with a history of exacerbation in the previous year and at least one nonpulmonary comorbidity assigned to intervention or usual care and followed for 9 months (n = 312) | Patients with global initiative for chronic obstructive lung disease grades II–IV COPD (median age, 71 yr [interquartile range, 66–76 yr]; 49.6% grade II, 50.4% grades III–IV), with a history of exacerbation in the previous year and at least one nonpulmonary comorbidity | Telemonitoring: CHROMED monitoring platform comprised a device that measured within‐breath respiratory mechanical impedance. Telemonitoring of physiological variables blood pressure, oxygen saturation, heart rate, and body temperature to reduce the frequency of hospitalization | Patients, physicians | Time to first hospitalization (TTFH) and change in the EuroQoL EQ‐5D utility index score | No group difference found on TTFH, EQ‐5D utility index score, antibiotic prescriptions, hospitalization rate, or questionnaire scores. (p > 0.05) In an exploratory analysis, daily telemonitoring was associated with fewer repeat hospitalizations (−54%; p = 0.017). |
| 2014 | Druss et al. 72 | Randomized trial of an electronic personal health record for patients with serious mental illnesses | To evaluate the effect of an electronic personal health record on the quality of medical care in a community mental health setting. | RCT of electronic personal health record of patients with serious mental illness and at least one chronic condition assigned to intervention or usual care and followed for 1 year (n = 170) | Mental illness + 1 chronic condition | PHR Web‐based application: Patients can access the personal health record data with protected passwords from any computer with an Internet connection. My Health Record is an adaptation of the existing Shared Care Plan: diagnosis, goals and action steps, health indicators, (BP, lipid and BG levels), medication, ALLG, hospital stay, immunization, medical and fam history. Patient reminder of preventive service | Patients, designated health partners (physicians, other providers, and friends and/or family) | Quality of medical care, patient activation, service use, and health‐related quality of life |
Having a personal health record was associated in improved quality of medical care. Quality of preventive services (p < 0.00001) and quality of cardiometabolic services (p < 0.003) Service use: Patient used personal health record a mean of 42.1 in 1 yr., In personal health record group, preventative services 24% increased to 40% (usual group decline from 25% to 18%)., increase in the # of outpatient visits in personal health record group (p < 0.001) |
| 2014 | Gellis et al. 73 | Integrated telehealth care for chronic illness and depression in geriatric home care patients: the integrated telehealth education and activation of mood (I‐TEAM) study | To evaluate an integrated telehealth intervention (integrated telehealth education and activation of mood [I‐TEAM]) to improve chronic illness (congestive heart failure,COPD), and comorbid depression in the home health care setting. | RCT of I‐TEAM in patients with CHF or COPD depression assigned to intervention or usual care and followed for 3 months (n = 102) | CHF or COPD (hospital admission/ED user, 3+ home care per wk.), + depression | Telemonitoring: The telemonitoring device comprised of a small in‐home monitor connected to an agency central station. Daily monitoring of WT, BP, pulse, pulse oxygenation, and temperature data, messaging with primary care provider. Provided chronic illness and depression care | Patients | Depression, health, problem solving, and health utilization (readmission, care, ED visit) at 3, 6, and 12 months | I‐TEAM group had fewer ED visits (p = 0.01), but did not have significantly fewer hospital days at 12 months (p = 0.06). |
| 2013 | Pecina et al. 74 a | Impact of Telemonitoring on older adults health‐related quality of life: The Tele‐ERA study | To assess the effect of a home telemonitoring intervention on patient's health‐related quality of life for PLWMCC. | RCT of telemonitoring for older patients with MCC assigned to intervention or usual care and followed for 1 year (n = 205) | Older adults with MCC and high risk as assessed by a risk assessment score | Telemonitoring, message and video conference: monitoring of biometric data (BP, WT, pulse, temp, pulse oxygenation, peak flow); administering symptom questionaries with goal of early detection of health status decline; all done with the Intel Health Guide. | Patient, nurse, geriatric nurse practitioner (NP), primary care physician (PCP) | QOL: physical and mental score on the short form health questionnaire PCS | Intervention yielded a decrease in PCS scores (−4.3 ± 9.3), compared to the usual care group (−1.2 ± 8.5) during the study (p = 0.03). No difference in the 12‐month PCS scores (p = 0.39) or MCS scores (p = 0.10) between groups |
| 2012 | Logan et al. 75 | Effect of home blood pressure telemonitoring with self‐care support on uncontrolled systolic hypertension in Diabetics | To test the system's effectiveness in a randomized controlled trial in diabetic patients with uncontrolled systolic hypertension. | RCT of telemonitoring for DM patients with uncontrolled HTN assigned to intervention or usual care and followed for 1 year (n = 110) | Adult 30 years and over recruited with DM and uncontrolled HTN | Telemonitoring: Bluetooth‐enabled home BP monitoring device paired with an app on a BlackBerry smartphone, readings trend and applied decision rules, self‐care messages to the patient's phone immediate after each reading, patient call to initiate an automated process to fax a one‐page summary report to provider | Patients, physicians | Systolic BP, target BP control of <130/80 mmHg, anxiety, depression, comfort with BP self‐monitoring changes in 7 days of home BP readings | The intervention (BP device + self‐care support) was associated with decreased in systolic BP by 9.1 ± 15.6 mmHg, (p = 0.003); compared to control group, providing self‐care support did not affect anxiety but worsened depression (p = 0.76 vs. p = 0.032) |
| 2012 | Takahashi et al. 76 a | A randomized controlled trial of telemonitoring in older adults with multiple health issues to prevent hospitalizations and emergency department visits | To determine the effectiveness of home telemonitoring compared with usual care in reducing the combined outcomes of hospitalization and emergency department visits in an at‐risk population 60 years of age or older. | RCT of telemonitoring for high‐risk older adults with MCCs living in assisted care (elderly risk assessment score > 16) assigned to intervention or usual care and followed for 1 year (n = 205) | High‐risk older adults with MCCs living in assisted care, elderly risk assessment score > 16 | Telemonitoring: Intel Health Guide, an FDA‐approved device/monitoring system capable of collecting biometric data (BP, WT, pulse, temp, pulse oxygenation, peak flow); symptom questionaries with goal of early detection of health status decline; message, video conference | Patient, nurse, geriatric NP, PCP | Hospitalization, ED visits over 1 year | Telemonitoring did not result in fewer hospitalizations or ED visits (p = 0.345). Mortality was higher in the telemonitoring 14.7%, versus 3.9% to usual care group (p = 0.008). |
| Non‐RCT | |||||||||
| 2019 | Steele Gray et al. 77 b | Using exploratory trials to identify relevant contexts and mechanisms in complex electronic health interventions: evaluating the electronic patient‐reported outcome tool | To use exploratory trial data to identify relevant context, process, and outcome variables, as well as central versus peripheral mechanisms at paly for the ePRO intervention. | Mixed method survey evaluating patients, providers, and administrators experience with the ePRO intervention assigned pre and post intervention and followed for 4 months (n = 24) | MCC patients |
Mobile and web‐based application: My Goal Tracker—ePRO tool and portal to support goal‐oriented care in primary care = uses goal‐attainment scaling to capture standardized outcome measures across diverse patient groups, standardize goal attainment measures, and address the challenge of writing multiple goal. ePRO also supports health status scales and outcome measures |
Patients, primary care provider, social worker, nursing staff, DM educator | QOL, self‐management, patient experience; provider effectiveness; system usability; goals attainments; person‐centeredness | Quantitative: No statistical difference in change scores between control and intervention arms. Assessment of Quality of Life Scale (p = 0.21) and Patient Assessment of Chronic Illness Care (p = 0.52) Qualitative?: Identify—perceived meaningfulness of the ePRO tool, assign roles and responsibilities to set up appropriate goals, pts remembering their goals, and monitoring if achieved or not was essential to meet outcomes reported in qualitative findings |
| 2019 | Easton et al. 78 | A virtual agent to support individuals living with physical and mental comorbidities: co‐design and acceptability testing | To co‐design the content, functionality, and interface modalities of an autonomous virtual agent to support self‐management for patients with an exemplar long‐term condition (COPD) and then to assess the acceptability and system content | Qualitative study of patients' and health professionals' experience design and development of an autonomous virtual agent with natural language processing capabilities (n = 11) | COPD, mental health, Comorbid long‐term conditions (LTCs) | Artificial intelligence‐based virtual agent: Avachat, a conversational agent is an autonomous virtual agent with natural language processing abilities for mapping a day in the life journey, mood boards, what situations it was advisable and acceptable to depart from the script to alert a provider or caregiver | Patients, clinicians | Content, functionality, and interface modalities of an autonomous virtual agent user acceptance | Patients and clinicians identified four priority scenarios pts like to receive support: (1) at the point of diagnosis—information provision; in the course of acute exacerbation—crisis support; (2) while in low mood—emotional support; (3) general self‐management motivation. Contents desired by patients were behavior change practices, emotional well‐being advice, and peer‐driven support. Based on the scenario testing 10 older adults with comorbidities felt acceptable to have both self‐management support and support for acute exacerbations from an AI‐based virtual agent |
| 2019 | Portz et al. 79 c | Using the technology acceptance model to explore user experience, intent to use, and use behavior of a patient portal among older adults with multiple chronic conditions: descriptive qualitative study | To use the Technology Acceptance Model (TAM) as a framework for qualitatively describing the (user interface) UI and (user experience) UX, intent to use, and use behaviors among older patients with MCC | Qualitative study of focus groups on Technology Acceptance Model (TAM) (n = 24) | Older adults (aged 65 years and over), with MCC, Charlson Comorbidity Index >2 | Web‐based application: My Health Manager is a patient portal for appointment, medical records (view test results, immunization, problem list, care plans), pharmacy (manage and order medication), health resources and self‐management tools, message (email provider), e‐visit and provider chat for non‐emergent questions/visits | Patients, providers | Usability, ease of use | Portal use affected by challenges related to log‐ins, UI design (color and font). Focus groups indicated that portal improved patient‐provider communication, saved time and money, provided appropriate health info. Intend to use functionalities that were valuable to their health management and easy to use |
| 2019 | Portz et al. 80 c | “Call a Teenager… That's What I Do!”—Grandchildren help older adults use new technologies: qualitative study | To explore older adults' experiences with technology support from family members to inform strategies for promoting adoption of new health technologies by older adults | Qualitative study of secondary analysis on family support themes from six focus groups assigned to user or nonuser groups (n = 24) | Older adults (65 year old and over) with MCC, Charlson Comorbidity Index >2 | Web‐portal Patient portal: The functionalities of the portal include appointment, medical records (view test results, immunization, problem list, care plans), pharmacy (manage and medication order), health resources and self‐management tools, message (email provider), e‐visit and provider chat for nonemergent questions/visits | Patients, providers, family members | Usability, training | Grandchildren and adult children are teaching their (grand)parents to use new technology, troubleshoot, and adapt new technologies to older adults; Family members faced difficulty when teaching tech use, they struggle to elucidate simple technology tasks and exasperated by the slow learning of older adults |
| 2018 | Hans et al. 81 b | The provider perspective: investigating the effect of the electronic patient‐reported outcome (ePRO) mobile application and portal on primary care provider workflow | To investigate how the ePRO mobile application and portal system, designed to capture patient‐reported measures to support self‐management, affected primary care provider workflows | Qualitative study of training notes, patient focus groups and provider focus groups, and issue tracker reports followed for 6 weeks (n = 18) | MCC (2+ conditions) | Mobile application and web‐based portal: Electronic patient reported, using a patient centered app and portal system developed by patient and professional collaboration previously outcome (wk./1 set health goals and monitoring protocol) | Patients, providers collaborating | PROMIS: global health scale; pain interference scale; health assessment questionnaire; GAD‐7; PHQ‐9 feasibility and effect of system on provider workflow |
ePRO application encouraged care planning and collaborative conversation on goal‐setting b/t patients and providers. Providers worried about lack of interoperability b/t app and EHR lead to increased documentation; Provider concerned on clinical workflow disruption and increased needs for patients' engagement. High level of provider opposition rather than adapting behavior, regular attempt to shift the app to fit with existing workflow |
| 2018 | Irfan Khan et al. 82 b | mHealth tools for the self‐management of patients with multimorbidity in primary care settings: pilot study to explore user experience | To explore the experience and expectations of patients with multimorbidity and their providers around the use of the ePRO tool in supporting self‐management efforts | Qualitative study of thematic analysis of focus groups followed for 4 weeks (n = 18) | MCC, social complexity | Mobile and web‐based application: ePRO (electronic patient reported outcome) mobile app is linked to the web portal. The platform is capable to support (1) set goals and track self‐management goals, and (2) a hospital discharge function to notify providers of hospital visits. | Patients, primary care provider, social worker, nursing staff, DM educator | Self‐management goals: (1) physical and social, (2) mood and memory, (3) mobility, (4) pain, and (5) WT/diet | From providers: ePRO offered important insights into the broader patient context that help formulate recommendation on self‐management approach and activities to pts; From patients perspectives: the tool advance access to providers in a team‐based primary care setting. But, both patients and providers highlighted: (1) lack more customization of content to better adapt to the complexity and fluidity of self‐management, (2) absence of direct provider engagement through the ePRO tool |
| 2017 | Middlemass et al. 83 | Perceptions on use of home telemonitoring in patients with long term conditions—concordance with the health information technology acceptance model (HITAM): a qualitative collective case study | To examine the usefulness of the HITAM for understanding acceptance of HIT in older people (≥60 years) participating in a RCT for older people with Chronic Obstructive Pulmonary Disease (COPD) and associated heart diseases (CHROMED). | Qualitative collective case study of interviews from a parent study clinical trial in patients and caregivers all assigned to the intervention arm and followed for 9 months (n = 21, n = 8 respectively) | COPD and CHF or ischemic heart disease | Telemonitoring: Telemonitoring devices used by health care professionals to received clinical alerts are the following: (1). Resmon pro©, monitored measure lung function of participants (2). The Wristclinic measured HR, ECG, BP, heart rhythm, RR, pulse oxygenation, temperature (3). A computer monitor for daily responses number of symptom questions relating to their illness. | Patients in their own home, caregivers | User behavior: use intention, beliefs, and attitudes Acceptance of tele‐monitoring using HITAM | HITAM can explain the likelihood that older people with LTCs would use HIT. HIT self‐efficacy depended on good organization factors and informal support, ease of use for older adults. HIT perceived usefulness correlated in seeing trends in health status, early detection of infection and potential to self‐manage. Factors of nonacceptance of HIT included: increased illness anxiety and fear, reinforcement of “Sick‐role”; insufficient support for self‐management due to inadequate feedback to user from clinicians |
| 2016 | Steele Gray et al. 84 b | The electronic patient reported outcome tool: testing usability and feasibility of a mobile app and portal to support care for patients with complex chronic disease and disability in primary care settings | To test the usability and feasibility of adopting the ePRO tool into a single interdisciplinary primary health care practice in Toronto, Canada | Mixed method design of pilot execution, descriptive statistics, content analysis, interviews, and focus groups followed for 4 weeks (n = 17) | Mobile and web portal application: Goal tracker and check out alert are two main features. Patients used Samsung Galaxy II android phones with the ePRO app uploaded to track their goals and report hospital visits using the Hospital discharge. The provider portal enables providers to set up care plans and to track patients ‘goals | Patients, primary care provider, social worker, nursing staff, DM educator | Feasibility, usability | Eight patients completed 210 monitoring protocols, 1300+ questions answered daily; patients and providers noted ePRO easy to use. From patients: it facilitated self‐manage (sense of responsibility over their care), improved patient‐centered care delivery; From providers: ePRO focused conversations on goal setting; However, ePRO did not well suited for provider workflow, monitoring questions were not well aligned with individual patient needs, daily reporting became burdensome and time consuming for patients | |
| 2011 | Pecina et al. 85 a | Telemonitoring increases patient awareness of health and prompts health‐related action: initial evaluation of the Tele‐ERA study | To assessing MCC patients opinions about their telemonitoring experience. | Qualitative and usability study of interviews of patients randomly selected from ongoing Trial (Tele‐ERA) (n = 20) | Telemonitoring: Intel Health Guide uses to monitor daily weight, blood pressure, heart rate, pulse oximetry, peak flow, and glucose level as well as ask questions on self‐reported symptoms | Patients | Usability and usefulness | MCC patients perceived telemonitoring be acceptable and satisfying. elderly patients noted that telemonitoring provided peace of mind; awareness; minimally difficulties, assertive in using the monitor, and helped with clinician communication | |
Abbreviations: ALLG, allergies; BG, blood glucose; BP, blood pressure; CHF, congested heart failure; COPD, chronic obstructive pulmonary disease; CVD, cardiovascular disease; DM, diabetes; ECG, electrocardiogram; ED, emergency department; EHR, electronic health record; ePRO, electronic patient reported outcome; health IT, health information technology; HR, heart rate; HTN, hypertension; MCC, multiple chronic conditions; PCS, Pain Catastrophizing Scale; PHR, personal health record; PLWMCC, people living with multiple chronic conditions; QOL, quality of life; RCT, randomized controlled trial; RR, respiration rate; SUS, system usability score; WT, weight.
a
Tele‐ERA study, Mayo Clinic Rochester Minnesota.
b
Health System Performance Research Network‐Bridgepoint electronic Patient‐Reported Outcomes mobile device and portal system in collaboration with QoC Health Inc., Toronto Canada.
c
My Health Manager, Kaiser Permanente Colorado.