The Effect of a Mobile Health App on Treatment Adherence and Revenue at Physical Health Clinics: Retrospective Record Review
Authors: Topp Robert , Greenstein Jay , Etnoyer-Slaski Jena 
Published: March 2023

Background
A significant number of patients do not adhere to their prescribed course of physical therapy or discharge themselves from care. Adhering to prescribed physical therapy, including attending physical therapy clinic appointments, contributes to patients achieving the goals of therapy including reducing pain and increasing functionality. Web-based platforms have been demonstrated to be effective means for managing clinical patients with musculoskeletal pain, similar to managing them in person. Behavior change techniques introduced through digital or web-based platforms can reduce nonadherence with prescribed physical therapy and improve patient outcomes. Literature also indicates that a phone-based app provided to patients, which includes a reward-incentive gamification to complement their care, contributed to a greater number of kept appointments in a physical therapy clinic.

Objective
This study aims to compare the rate of provider discharge with self-discharge and the number of clinic visits among patients attending a physical health clinic who did and did not choose to adopt a phone-based app to complement their care. A secondary purpose was to compare the revenue generated by patients attending a physical health clinic who did and did not choose to adopt a phone-based app to complement their care.

Methods
A retrospective analysis of all new outpatient medical records (N=5328) from a multisite physical health practice was conducted between January 2018 and December 2019. Patients in the sample self-selected the 2018 Usual Care, the 2019 Usual Care, or the 2019 Kanvas App groups. Kanvas is a customized private practice app, designed for patient engagement with their specific health care provider. This app included a gamification system that provided rewards to the patient for attending their scheduled clinic appointments. According to their medical record, each patient was classified as completing their prescribed therapy (provider discharged) or not completing their prescribed therapy (self-discharged). Additionally, the total number of clinic visits each patient attended, the total charges for services, and the total payments received by the clinic per patient were extracted from each patient’s medical record.

Results
Patients in the 2019 Kanvas App Group exhibited a higher rate of provider discharge compared to patients who did not adopt the app. This greater rate of provider discharges among the patients who adopted the Kanvas app likely contributed to this group attending more clinic visits (13.21, SD 12.09) than the other study groups who did not download the app (10.72, SD 9.80 to 11.35, SD 11.10). This greater number of clinic visits in turn contributed to the patients who adopted the app generating more clinic charges and payments.

Conclusions
Future investigators need to employ more rigorous methods to confirm these findings, and clinicians need to weigh the anticipated benefits against the cost and staff involvement in managing the Kanvas app.