Investigators develop mobile care plan for patients with kidney stones

Jenny Guo, MD

In this interview, Jenny Guo, MD, provides an overview of a mobile care plan for kidney stone management that was evaluated in the 2024 American Urological Association Annual Meeting abstract, “Development of a novel mobile health platform for surveillance of kidney stone formers: 6-month preliminary analysis.” Guo is a urology resident at Northwestern University Feinberg School of Medicine.

Please provide an overview of the mobile care plan you and your coauthors developed.

We collaborated with a digital patient care management platform known as GetWell Loop. They're used here at Northwestern throughout the hospital. We specifically partnered with them to create a customized kidney stone mobile health care plan for patients with chronic stones. It incorporates patient-specific data to reinforce dietary management, fluid intake, and medication adherence based on the patient's 24-hour urine collection results. And so we sought to conduct a randomized controlled trial comparing the usage of GetWell Loop to a standardized in-person clinic follow-up. How it worked was the GetWell patients come in for an initial clinic visit, and then the idea is that they won't come back to see us for an entire year. So for the entirety of the 1-year period, they will use the app to monitor and to prevent stone recurrences, whereas the patients in our standardized follow-up pathway come back every 6 months for a visit. Regardless of what group the patient is in, both groups will obtain a 6-month 24-hour urine collection so we can have more quantitative data to see if they are following and adhering to our recommendations. The app itself works through something called a check-in process. The patient will be enrolled into the mobile health plan, and they receive check-ins every 3 months, so a total of 5 check-ins. The check-ins are similar to short surveys, and it'll ask patients questions that are specific to their 24-hour urine collection results. For example, are you low in citrate, and if the patient clicks, "yes," based on their 24-hour urine collection result, then the app will proceed to give them information on dietary and medication changes that they can make. And it also includes monthly reminders for fluid intake, as well as medication reminders to make sure that the patients are taking their medications regularly. On top of that, the app itself is pretty streamlined. It's completely incorporated within the Epic MyChart system. So the patients don't need an extra login; they can easily access GetWell Loop directly through their Epic MyChart, so it's almost like an app within an app. And then from the provider side of things, it's also very streamlined. You don't need an additional login or an app to access like an additional website. It's all within Epic under the dashboard. For those reasons, we thought this was very streamlined, and potentially a good way to monitor these patients.

What were some of the notable findings of your study?

So far, we've analyzed our 6-month preliminary results. Unfortunately, we've had a pretty difficult time enrolling patients into this study; we've had about a 35% enrollment rate over the past 12 months. But interestingly enough, so far, at 6 months, we found that the GetWell patients have shown increases in their Wisconsin Stone Quality of Life scores, or the WISQOL score, of about 3 points from baseline to 6 months, whereas in the control group, patients actually showed a decrease of about 0.7 points from baseline. But given the low recruitment rate, we have a pretty low sample size, so these results aren't statistically significant. Looking at the 24-hour urine collection results, we found that the GetWell patients actually had increases in their urine volume from baseline to 6 months of about 0.35 liters, whereas the control patients didn't really show any change at all.

Do you plan to conduct further research on the care plan?

Currently, we don't have any future studies planned. But we're definitely thinking of ways to refine the usage of some sort of mobile application or mobile device because it seems like patients are interested in trying out mobile health technology. However, we still need to find better ways to streamline the process to make it less lengthy and less cumbersome to use. So for example, we're thinking of possibly looking into incorporating AI or reaching out to the engineering department to create our own application. That way, the patient doesn't need to log in to use the application to access their results, and they can hopefully, in the future, input their 24-hour urine collection results themselves directly into the app, and the app will analyze their results and give them customized recommendations, and then enroll them into a care plan that could theoretically provide them with notifications and fluid and medication reminders.

What is the take-home message for the practicing urologist?

I would say the take-home message is that usage of this mobile health platform could potentially improve patient quality of life and compliance with recommendations. However, it does appear that most of the participants in our study tended to be younger or very highly motivated to use mobile health technology to prevent future stone recurrences. And we did see a pretty low recruitment and higher dropout rates than expected. So that may also point toward the fact that patients may value in-person follow-up and just prefer to see somebody face to face. So we definitely need some further studies to refine this technology and to see if it will really be useful. It'd be interesting to see in 10 to 20 years down the line if there's a shift in attitude toward usage of mobile health technology in prevention of stones.

Is there anything you would like to add?

I always want to emphasize that kidney stones are very common in the US. They occur in about 1 out of 10 to 11 people, and patients who have 1 stone oftentimes will have a recurrence; 1 in 5 will have a recurrence, so it's always important to continue doing research to prevent stones in the future.

This transcription was edited for clarity.