JMIR Publications

ABSTRACT

Background:

Migraine is a common major cause of disability, poor quality of life, and high health care utilization. Access to evidence-based migraine care is limited and projected to worsen. Novel health care delivery models including mHealth app-based tools may mitigate these challenges.

Objective:

We developed an electronic health record (EHR) integrated mobile app-based migraine interactive care plan (MICP) to remotely monitor, deliver education and facilitate care team communication for patients with migraine. This multi-method study describes the MICP and pilot evaluation of its feasibility, usability, and impact on care teams in a community neurology practice.

Methods:

Consecutive enrollees between 9/1/2020 and 2/16/2022 were assessed in a single arm observational study. Usability was defined by ≥ 75% of patients completing ≥ 1 assigned task. Task response rates, rate and type of care team escalations, and patient reported clinical outcomes were summarized. Feasibility was defined by equal-to or fewer downstream face-to-face visits, telephone contacts, and electronic messages. From 9/1/2020 to 9/1/21 eligible patients were prospectively recruited and randomly assigned to routine care with or without the MICP. Demographic data and occurrence of face-to-face visits, telephone contacts, electronic messages were extracted from the EHR. The Wilcoxon ranked summed test was used to compare continuous variables and the Chi-square test for categorical variables for those with at least 3 months of follow-up.

Results:

A total of 171 patients enrolled and 127 (74.3%) completed ≥ 1 MICP assigned task. Mean escalations per patient per month was 0.9 (SD 0.37; range 0-1.7). Patient confirmed understanding of educational materials ranged from 26.7% to 56.3%. Initial mean headache days per week was 4.54 days (SD 2.06) and trended down to 2.86 days (SD 1.87) at week 26. Baseline mean total MIDAS score was 110 (SD 107; range 3-452) with a response rate of 59% (n=100/170). The percentage of patients reporting favorable satisfaction increased from a baseline of 35% to 59% (response rate of 30-41%) over the first 6 months. A total of 121 with MICP were compared to 62 patients in the control group. No differences were observed in the rate of telephone contacts or electronic messages. Fewer face-to-face visits were observed in the MICP cohort (n=13/121, 10.7%) compared to controls (n=26/62, 42%; P < .001).

Conclusions:

We describe successful implementation of an EHR integrated mobile app-based interactive care plan for migraine in a community neurology practice. Our findings suggest that the MICP holds potential for improving patient access and reducing healthcare utilization without increasing care team work. Additional studies are needed to assess the impact on utilization and outcomes in other settings such as primary care. Our findings also suggest the need for direct patient input from diverse populations to improve the MICP and sustain patient-engagement.