Technology-based innovations for increasing cancer screening

Transcription

1 Technology-based innovations for increasing cancer screening David P. Miller, MD, MS, FACP Associate Director, Clinical and Translational Science Institute Professor, Internal Medicine and Public Health Sciences

2 Rapidly Becoming a Digital World Rapidly becoming a digital world Smith A. Pew Research Center. Jan 12, 2017.

3 Healthcare vs. Corporate world: Which is easier? VS. Schedule a subspecialty doctor visit Book a trip to Paris (window seat, vegan meal)

4 Mobile Health (mhealth) Medical and public health practice supported by mobile devices, such as mobile phones, patient monitoring devices, personal digital assistants, and other wireless devices. World Health Organization, 2011

5 WHY consider mhealth solutions To save time (patient and clinician) To assist with complex decisions To educate patients

6 Healthcare System Challenge #1: No Time A typical family physician needs 7.4 hours per day just to cover the USPSTF recommended guidelines (in 1996) Caring for the top 10 chronic diseases: Add 3.5 hours per day (if controlled) Add 10.6 hours per day (if uncontrolled) TIME REQUIRED = hours per day Yarnall KS. Am J Public Health 2003 Ostbye T. Ann Fam Med 2005

7 Challenge #2: Complex Decisions Case Example: Lung cancer screening Approved by Medicare for: Current and former smokers Ages Smoked at least 30 pack-years If quit, quit less than 15 years ago Centers for Medicare & Medicaid. Feb 5, 2015.

8 If you screen 1,000 people for lung cancer once a year for 3 years, here is what happens: Risk of Lung Cancer (in those qualifying for screening) Number Needed to Screen False positives/ life saved Low (lowest quintile) Average High (highest quintile) Kovalchik S. NEJM 2013.

9 Challenge #3: Patient comprehension Patients remember less than 50% of what we discuss with them in an encounter Patients who have the greatest difficulty understanding what we are saying are the LEAST likely to ask questions Katz MG. J Gen Intern Med 2007.

10 Advantages of Mobile Devices Aren t pressured by time Can deliver a consistent message (in simple language) Can repeat information Can tailor the information presented Can save clinicians/staff time

11 Cancer Screening mhealth Apps mpath Lung mpath CRC

12 mpath-lung Screening Program EHR Query Invitation via Patient Portal mpath Lung Web App Age Smoking History Absence of significant comorbidities

13 Patient Portal Invitation From: mpath Team A new screening test can significantly lower a person s chance of dying from lung cancer. An automated analysis of your Wake Forest Baptist Health record indicates you may qualify for this test. To learn more, click here.

14 mpath-lung Web App

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17 Web App Decision Aid

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20 mpath-crc

21 mpath-crc (mobile PAtient Technology for Health) Patient Provider/System Follow-up Support Encourages screening Allows self-ordering of screening tests Assists patients at home mpath program Text/ Messages

22 mpath-crc: Screening Decision Aid

23 mpath Screenshots: User Training

24 mpath Screenshots: Survey

25 CRC Screening Decision Aid

26 Patients order their own screening

27 Supportive Feedback

28 Optional text messages or s

29 mpath-crc Randomized controlled trial in 6 primary care clinics N = 450 patients Outcomes: Screening decisions Tests ordered Tests completed Final data collected December 2016

30 Sample Demographics (n=450) Participant Characteristic Female, n (%) 242 (54%) Age, median (range) 57 (50 74) Health Disparate Population, n (%) Limited health literacy Income < $20,000 Black race 305 (69%) 166 (37%) 231 (51%) 169 (38%)

31 Patient ability to complete program without any assistance Patient Characteristic Total in Group No Assistance Needed, n (%) Overall (93%) Age > (88%) No internet use (85%) Miller DP et al. JMIR mhealth uhealth 2017.

32 100% Screening preferences, orders, and completion 90% 80% 70% 69% 60% 50% Manuscript Under Review 40% 30% 20% 10% 0% mpath 32% Control Test ordered (Within 24 weeks) 30% mpath 15% Con Test completed (Within 24 weeks) All comparisons, p<0.0001

33 Closing Thoughts Older adults use of technology will only increase in the future. Medicine must embrace digital strategies to meaningfully improve health. Technology shouldn t replace doctors, but should offload routine tasks. We will see many more technology-based health innovations in the coming years.

34 mpath Collaborators Ajay Dharod, MD L. Doug Case, PhD Nancy Denizard-Thompson, MD Donna Lawler Christina Bellinger, MD Kristie Foley, PhD Andrea Nance John Spangler, MD, MPH Kathryn Weaver, PhD, MPH Don Babcock, PE Michael Pignone, MD, MPH Jennifer Troyer, PhD Creative Communications Supported by: NCI 5R01CA178941, NCI CCSG P30CA012197, NCATS UL1TR001420

35 Questions/Comments?