Accepted for/Published in: JMIR Medical Informatics
Date Submitted: Jan 12, 2020
Date Accepted: Mar 30, 2020
A Smartphone Application to Manage Outpatient Cirrhotic Ascites: A Feasibility Study
ABSTRACT
Background:
Ascites is a common, painful, and dangerous complication of cirrhosis. Body weight is a reliable proxy for ascites volume; therefore, daily weight monitoring is recommended to optimize ascites management.
Objective:
This study evaluates the feasibility of a Smartphone application in facilitating outpatient ascites management.
Methods:
In this feasibility study, cirrhotic patients with ascites requiring active management were identified in both the inpatient or outpatient setting. Patients were provided with a Bluetooth-connected scale, which transmitted weight data to a Smartphone application, and then via the internet to the electronic medical record (EMR). Weights were monitored every weekday. In the event of a weight change ≥ 5lbs in 1 week, patients were called and administered a short symptom questionnaire, and providers received an email alert. The primary outcomes of this study were percentage of enrolled days during which weight data was successfully transmitted to the EMR, and the percentage of weight alerts which prompted a response by the provider.
Results:
Twenty-five patients were enrolled: 12 (48%) were male and mean age was 58 years (range 35-81 years). Eighteen (72%) were enrolled as inpatients. Cirrhosis etiology was alcohol-related in 44%, non-alcoholic steatohepatitis in 36%, and viral in 12%. Weight data was successfully transmitted to the EMR during 71% of study enrollment days, with technology issues reported on 17% of days. Of a total 79 weight change alerts fired, 41 (52%) were triggered by weight loss and 38 (48%) by weight gain. Providers responded in some fashion to 84% of weight alerts, and intervened in response to 57% of alerts, for example by contacting the patient, scheduling clinic or paracentesis appointments, modifying the diuretic dose or requesting laboratory workup. Fifteen (60%) patients chose to extend their participation beyond 30 days. Seventeen readmissions occurred during the study period, with only 4 related to ascites.
Conclusions:
We demonstrate the feasibility of a Smartphone application in facilitating the management of ascites. We report excellent rates of patient and provider engagement. This innovation could enable early therapeutic intervention, decreasing the burden of morbidity and mortality among cirrhotic patients. Clinical Trial: NA
Citation
Request queued. Please wait while the file is being generated. It may take some time.
Copyright
© The authors. All rights reserved. This is a privileged document currently under peer-review/community review (or an accepted/rejected manuscript). Authors have provided JMIR Publications with an exclusive license to publish this preprint on it's website for review and ahead-of-print citation purposes only. While the final peer-reviewed paper may be licensed under a cc-by license on publication, at this stage authors and publisher expressively prohibit redistribution of this draft paper other than for review purposes.