Supporting goal-oriented care using mobile technology: Findings from the mixed-methods trial of the ePRO tool.

Area of Science:

• Gerontology and Primary Care
• Digital Health Implementation
• Health Services Research

Background:

• Goal-oriented care models are increasingly used for older adults with multimorbidity.
• Implementation of these models is challenging, with digital health solutions offering potential but requiring evaluation.
• Electronic Patient Reported Outcome (ePRO) tools aim to support goal-oriented care delivery.

Purpose of the Study:

• To evaluate the implementation and effectiveness of an ePRO mobile application and portal system.
• To assess the feasibility and impact of ePRO in inter-professional primary care practices for older adults with complex needs.

Main Methods:

• A multi-method pragmatic randomized control trial with a stepped-wedge design over 15 months.
• Involved 6 primary care practices in Ontario, targeting 176 older adults with complex care needs.
• Utilized the Assessment of Quality of Life-4D for outcomes and ethnographic methods (observations, interviews) for implementation insights, analyzed via linear and qualitative methods.

Main Results:

• Recruitment challenges led to fewer sites (n=6) and participants (n=45) than planned, limiting definitive quality of life impact assessment.
• Analysis trends indicated a potential decrease in patient quality of life during both control and intervention periods.
• Ethnographic data highlighted that the perceived meaningfulness of the ePRO technology to users' lives and chronic disease management influenced adoption and value.

Conclusions:

• Implementation faced broad and unexpected challenges, particularly in aligning the technology's meaningfulness across diverse users.
• The intervention's adaptability and the need for more dynamic trial methodologies are suggested.
• Ethnographic data is crucial for understanding the underlying mechanisms driving digital health innovation adoption.