In our recent webinar of the Digital Rheumatology Network, we invited Prof. Jeffery Curtis, a Professor of Medicine at the University of Alabama at Birmingham, who is an expert in rheumatology and an early adopter of telemedicine in the field. In his presentation he shed light on the transformative impact of digital monitoring in the field of rheumatology. The discussion revolved around an interesting study design and its application, showcasing how patients’ self-reported data through smartphone apps could significantly enhance our understanding of medication side effects, disease activity, and overall patient well-being.
The Self-Controlled Case Series Study Design:
Prof. Jeffery Curtis introduced a novel study design known as the self-controlled case series, emphasizing its efficiency in comparing individuals to themselves during intermittent exposures. This design, widely used in epidemiology, was employed to assess the effects of weekly methotrexate doses on patients. The study successfully demonstrated that collecting digital data via smartphone apps right after medication doses could reveal statistically significant increases in nausea and fatigue for a substantial portion of patients.
Unlocking Patient-Reported Outcomes:
The study revealed that patients willingly provided valuable data through validated patient-reported outcome instruments, facilitating the detection of medication side effects in a manner unfeasible in traditional clinical trials. Prof. Jeffery Curtis emphasized the importance of leveraging this patient-driven data to gain insights into medication impacts.
Wearable Integration and Patient Compliance:
The presentation delved into the integration of wearables into the research protocol. The results showcased impressive patient compliance, with over 80% adherence to both weekly patient-reported outcome measures and wearables. This provided a foundation of confidence that individuals are willing to engage in long-term digital monitoring.
Identifying Non-Compliance Early:
Prof. Jeffery Curtis highlighted the importance of a run-in period to identify patients who may not consistently provide digital data. The data showed that non-compliance often manifested early, within the first few days. This emphasized the need for proactive strategies to engage patients and maintain consistent data collection.
Machine Learning for Disease Activity Classification:
The presentation moved beyond data collection to explore the potential of machine learning in predicting disease activity. By applying machine learning models to patient data collected via smartphone apps, the study achieved an 84% positive predictive value for classifying low disease activity. This innovative approach demonstrated the capability to assess disease status without the need for in-person visits.
Digital Monitoring in Clinical Care:
Transitioning from research to clinical care, Prof. Jeffery Curtis discussed how digital monitoring became insurance reimbursable, particularly under the Medicare program. The shift towards using smartphone apps as medical devices led to the introduction of new procedure codes, facilitating remote patient monitoring for various health conditions.
Implementation Challenges and Future Considerations:
Despite the evident benefits, the presentation acknowledged challenges in implementing digital monitoring at scale. Issues such as workforce training, patient engagement, and evolving reimbursement models were discussed as key areas that demand attention.
Digital Ecosystem for Research:
The presentation concluded with a glimpse into the potential for creating a digital ecosystem for research. He highlighted ongoing collaborative studies and the use of practice-based research networks to leverage data collected for clinical care for furthering research initiatives.
Prof Jeffery Curtis presentation offered a comprehensive exploration of the transformative role of digital monitoring in rheumatology. From innovative study designs to the application of machine learning, the insights shared pave the way for a new era in patient care and research. As the field continues to embrace digital technologies, the potential to revolutionize rheumatological care appears promising.
Jeffrey Curtis MD MS MPH
Harbart-Ball Endowed Professor of Medicine, Epidemiology, and Computer Science
Division of Clinical Immunology & Rheumatology, Department of Medicine
University of Alabama at Birmingham
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