Article Text
PDF
Statistics from Altmetric.com
- regional anesthesia
- anticoagulants
- technology
- injections
- spinal
- drug-related side effects and adverse reactions
Introduction
Delays in translating new research and guidelines into clinical practice can waste resources, increase preventable harm and reduce patient benefit.1 2 Multiple studies estimate that it takes on average 17 years for new research to meaningfully affect bedside care.1 Guideline creation and distribution are an integral part of this timeline. Physicians report several obstacles to guideline adherence including too much information, difficulty in applying the information, and inadequate access to the latest version.3
The American Society of Regional Anesthesia and Pain Medicine (ASRA) periodically updates its guidelines for anticoagulation in patients receiving a regional anesthetic, with the latest update in 2018.4 Our group developed ASRA Coags, a smartphone application (app), to distribute the guidelines in a manner that makes them easy to use.5 We hypothesized that this app could speed distribution of this update to an existing user base, dramatically accelerating the guideline distribution component of the 17-year time lag.
Materials and methods
V.1.0 of the ASRA Coags app was released in April 2014. V.2.0 was released in April 2018 including the latest edition of the guidelines. In July 2018, V.2.1 was published to include an erratum to the original guideline published in the journal.6 Downloads and update metrics were collected from www.appfigures.com. Total downloads of V.1 of the app were tabulated through March 31 2018 representing the existing user base prior to V.2.0. We collected the total number of daily updates and calculated the daily cumulative percentage of users running V.2.0 after its release on April 11 2018. Data were collected for 30 days. Percentage of users was defined as the total number of users running V.2.0 divided by the existing user base as of March 31 2018. De novo installs of V.2.0 after April 11 2018 were not included. This data collection was repeated for V.2.1 which was released on August 1 2018, with user base of V.2.0 tabulated as of July 31 2018.
Results
The existing user base of V.1 was 28 319. After 7 days of the V.2.0 release, 83.2% (23,566) were updated and after 30 days, 93.1% (26,367) were updated (figure 1). In addition, there were 1385 new downloads of V.2.0 during these 30 days.
App V.2.0 updates by day. Daily app updates (columns) are referenced from day 0 representing the V.2.0 release date. Percentage updated (line) calculated as the total apps updated to V.2.0 divided by the total number of apps downloaded prior to the release date. ASRA, American Society of Regional Anesthesia and Pain Medicine.
The existing user base of V.2.0 was 32 644. After 7 days of the V.2.1 release, 80.8% (26,363) were updated and after 30 days, 90.5% (29, 550) were updated (figure 2). During this time, there were an additional 1087 new downloads of V.2.1.
App V.2.1 updates by day. Daily updates (columns) are referenced from day 0 representing the V.2.1 release date. Percentage updated (line) calculated as the total apps updated to V.2.1 divided by the total number of apps downloaded prior to the release date. ASRA, American Society of Regional Anesthesia and Pain Medicine.
Discussion
While traditional translational research can take an average of 17 years, we showed that with a smartphone-app platform we could accelerate an important component of this time lag with efficient and reproducible distribution of guidelines. In our evaluation, more than 90% of our existing user base updated to the latest guidelines within 1 month of the new guidelines being available.
However, even though we can observe app updates using this method, this does not assure that clinicians are accessing this new information or using it appropriately in clinical practice. Future studies are needed to more finely understand how the app is being used by clinicians, whether they are following the newest guidelines, and whether this results in better patient outcomes.
Thoughtful collaboration between experts in the medical subject matter, app developers who can leverage smartphone technologies, and liaisons that can straddle both medicine and technology are critical team elements that should be included from the beginning of any new guideline development.
Footnotes
Twitter @dr_rajgupta
Contributors RKG: lead author for the design of data collection, analysis and manuscript writing. TH: contributed significantly to manuscript writing, review of intellectual content, finalizing manuscript, and responses to reviewers. MDM: contributed significantly to manuscript writing, review of intellectual content, finalizing manuscript and responses to reviewers.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests RKG and MDM are the two lead developers and inventors of the ASRA Coags apps. A portion of the royalties from the app goes to Vanderbilt University Medical Center and the VUMC Department of Anesthesiology. The portion of the royalties directed towards RKG and MDM based on institutional guidelines is forwarded to a Departmental Innovation Grant Fund that is not under the control of the authors. Neither individual receives any personal remuneration from these royalties. TH has no relevant disclosures related to this manuscript.
Patient consent for publication Not required.
Ethics approval The Vanderbilt University Medical Center Institutional Review Board determined this study to be exempt (not “human subject” research and de-identified data).
Provenance and peer review Not commissioned; externally peer reviewed.