Picture this: A 50-year-old patient schedules her annual checkup. When she visits the doctor’s office, she completes paperwork and then receives an iPad and headphones before the doctor visit. On the iPad, she has the ability to self-order a test that could save her life – a screening test for colorectal cancer.
The patient hadn’t thought about this screening until now, but she clicks a button to order the test, just as quickly as she might shop online. After her checkup, she’s glad she ordered the test beforehand because she only had limited time to talk about all of her other health questions with her doctor.
“Detecting colorectal cancer early can save health care costs and lives,” said Jennifer Troyer, health economist at UNC Charlotte and interim dean of the College of Health and Human Services. Screening for colorectal cancer reduces mortality, yet more than one third of Americans over the age of 50 are unscreened. Meanwhile, colon cancer remains the second leading cause of cancer death in the United States.
Through a grant from the National Institutes of Health and National Cancer Institute, Troyer worked with researchers at Wake Forest University, UNC Chapel Hill and University of Texas to examine how digital technology can be used to increase the likelihood that patients order a colorectal screening procedure.
In the study, conducted at six North Carolina sites with 450 patients who were due for screenings, some patients received an iPad with the Mobile Patient Technology for Health-CRC (mPATH-CRC) app. Those with the iPad had the ability to order a test, while a control group watched a video about diet and exercise. Patients using the mPATH-CRC iPad app had the ability to order two kinds of tests: a fecal blood test or a colonoscopy. Both tests were ordered more frequently by patients with the app before the doctor visit.
“We found that the patients in the group who used the digital intervention were twice as likely as the control group to order a colorectal screening test, resulting in cost savings for the doctor who has limited time with each patient,” Troyer said. “Colorectal cancer is treatable in the early stages, yet many people put off getting a test or don’t talk with their doctor about screening. A self-order using this technology provides an immediate, direct action for patients to take the step they might be delaying. Such digital health interventions can improve health care delivery while lowering operational costs.”
“Compared to care without the mPATH-CRC iPad app, the technology resulted in an extra 33 completed screening tests and an extra 10 diagnosed cases of colorectal neoplasia among the 223 patients who used the app,” Troyer said.
As a health economist, Troyer studied the cost of the technology, equipment and staff time associated with the new iPad app. She led a part of the research to analyze clinical operations data from the iPad app intervention to estimate implementation costs. The results indicated that net costs for setup and operations were approximately $567 for the 233 patients that used the technology – costing just $2.54 per patient. Troyer and the research team found significant physician time savings because the technology could do the following: confirm patient eligibility, discuss screening options and order tests – actions the physician did not have to take.
Troyer said that as more patients use the technology, the costs per patient would fall.
“Based on the setup and operational costs, the total cost of the system falls to $0 if at least 14 patients per month use the system,” she said.
The researchers found that self-orders via digital technology could have the potential to impact other types of health screenings as well, which in turn can result in earlier detection of health issues.
The research was published in the Annals of Internal Medicine and presented at the Society for General Internal Medicine Annual Meeting.
Funding for the study was provided by the National Cancer Institute, RO1CA178941, as well as institutional support from Wake Forest Baptist.
Co-authors are: David Miller, M.D., professor of internal medicine at Wake Forest Baptist; Nancy Denizard-Thompson, M.D.; Kathryn Weaver, Ph.D.; L. Doug Case, Ph.D.; John Spangler, M.D.; and Donna Lawler, of Wake Forest Baptist; Jennifer L. Troyer, Ph.D., of the University of North Carolina at Charlotte; and Michael P. Pignone, M.D., of the University of Texas Dell Medical School.