Long-term clinical impact of an mhealth intervention for lung recipients

Purpose: Mobile health (mHealth) interventions have the potential to help lung transplant recipients (LTxRs) follow their complex post-transplant medical regimen. Investigators at our center developed one such mHealth intervention, PocketPATH, to assist LTxRs with self-management and provide decision support. A recent single-site randomized controlled trial showed that LTxRs assigned to PocketPATH, compared to those assigned to standard paper tracking logs, were more likely to self-monitor, adhere to requirements about checking spirometry and vitals, and communicate critical condition changes to the LTx team during their first year after transplant. Here, we examine whether these short-term benefits are associated with longer-term clinical outcomes. Methods: Among 182 LTxRs who survived the 1-year PocketPATH trial noted above, we ascertained time to patient death and bronchiolitis obliterans syndrome (BOS) from medical records. Cox regression determined whether (a) group assignment and (b) performance of self-management behaviors during year 1 (ie, self-monitoring; adhering to requirements for checking spirometry and vitals; communicating with the LTx team) predicted survival and BOS. Effects were adjusted for transplant-related factors known to impact clinical outcomes (eg, LTx type, LTx indication). Results: Median follow-up was 4.2 years post-transplant (range: 2.7-5.7). There was no effect of assignment to PocketPATH on survival and BOS (all p's> .05). However, among LTxRs who identified critical condition changes, reporting more of these changes to the LTx team reduced the risk of death (HR,.096; 95% CI,.02-.5; p= .005), independent of group assignment. Adherence to checking spirometry and vitals was not associated with either outcome (all p's> .05). Conclusion: Although there was no direct intervention effect on longer-term clinical outcomes, receiving PocketPATH had a significant indirect effect on survival by promoting LTxRs' reporting of critical condition changes to the LTx team during the first year after transplant. Facilitating patient-initiated communication about condition changes that warrant clinical attention may be an important mechanism by which mHealth interventions can improve long-term post-transplant health.