Asthma Tracker mHealth App Reduces Children's Hospital Admissions by 60%

^{Photo/Thumb have been modified. Courtesy of Bryan Stone.}

Children who used an asthma-tracking mobile health (mHealth) app that offers real-time data to parents and physicians had 60% fewer emergency department and hospital visits than children who did not use the app, according to the results of a study published in the journal Pediatrics.

Additional findings include a 35% reduction in the use of oral steroids and 60% fewer missed school days compared to those who did not use the mHealth app. The parents of children who used the tracker missed 70% fewer days of work.

“It’s exciting to see that using an effective app can not only help improve the lives of children with asthma and their parents, but also allow their providers to give optimal care,” said lead author Flory Nkoy, M.D., MPH, professor of pediatrics at University of Utah Health.

Nkoy, along with senior author Bryan Stone, M.D., University of Utah Health hospitalist, and other scientists and physicians at University of Utah Health, designed the eAsthma Tracker to continually monitor asthma in children.

The tracker monitors children with asthma at home and intervenes in time to prevent a flare-up. The app sends parents and doctors data in real time and triggers an automated alert when the asthma is acting up. When the alert is sent, the app prompts parents to make an appointment with the child’s doctor. Doctors who receive the alert could be proactive and call parents to determine how to solve the issue.

More than 300 children and parents at 11 pediatric clinics in Utah enrolled in the study to use the eAsthma Tracker for one year.

To be included, children needed to be between two and 17 years old with persistent asthma who received care in the previous year at a participating clinic, spoke English and had internet access.

The team analyzed longitudinal changes for the child and parents, including asthma control and missed school time and workdays. Researchers also compared the pre- and post-intervention differences in emergency department and hospital admissions and oral corticosteroid among the participants and a control group.

Participants who used the tracker filled out a brief weekly survey based on the Asthma Control Test. The app assigned a score that reflected how often the child used medication to control symptoms and if the child had difficulty completing daily activities.

The tracker issued recommendations based on whether a child is categorized as severe (red — score of 15 or lower), under control (green — 20 to 25) or approaching severe (yellow — 15 to 19).

The app included automated reminders to maintain adherence to the program, real-time results graphing, alerts via email or text or clinic dashboard for all stakeholders and real-time recommendations.

To promote adherence, the tracker included a progress bar that added 25 points per completion of an assessment. When participants reached 100 points, the tracker prompted a congratulatory message with digital fireworks and a $10 gift certificate. A leader board allowed users to see the weekly adherence of the top five de-identified users.

After completion of the program, the average quality of life score significantly increased from 79.1 at baseline to 90.9 at three months, 90 at six months and 90.6 at 12 months. Asthma control score improved from 18.8 at baseline to 22.3 after the first quarter of the intervention, 22.8 after the second, 22.8 after the third and 22.9 after the fourth.

The overall number of interrupted or missed school days decreased from 1.91 at baseline to 0.79 at three months, 0.52 at six months and 0.79 at 12 months. Interrupted or missed work days decreased from 0.72 to 0.27 at three months, 0.25 at six months and 0.2 at 12 months.

With reduction in emergency department and hospital visits, the tool has the potential to reduce healthcare costs and burden on patients and their families.

“We are optimistic that the spread of eAsthma Tracker can significantly improve asthma care and reduce asthma-related healthcare costs,” said Nkoy.

Stone and Nkoy are working to conduct market validation and develop a strategy to expand the reach of the eAsthma Tracker.

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