Laura Hult

Background: The longitudinal assessment of patient-reported outcomes (PROs) and physical activity is critical for patients with peripheral vascular disease (PVD) but challenging to accomplish in routine clinic practice. The U-STEP (Utah Vascular Surgery Health Maintenance App) is an open-source iOS smartphone application (app) that was designed to simplify the capture of PROs by notifying patients monthly to complete self-reported health questionnaires and fitness assessments. This study seeks to understand provider perceptions and patient reach of U-STEP implementation into clinical care for patients with PVD.

Methods: A physician focus group among 8 participants was conducted pre-implementation of U-STEP to understand barriers and facilitators. Patients with confirmed PVD were then recruited to download the U-STEP app between July – September 2024. Patients were identified and either approached during clinical visits or through mailed informational packets with follow-up phone calls. Patients were excluded if they could not complete the questionnaires in English or did not have a compatible iOS device.

Results: Physicians identified low digital literacy and limited physician time available to help with technology assistance as barriers. The clinical utility of patient activity trends, available technology assistance, and use of marketing posters were identified as facilitators. Following implementation of U-STEP, 248 PVD patients were screened for eligibility. A total of 127 patients were ineligible: 31 had limited English proficiency and 96 did not have a compatible iOS device. 8 had limited digital literacy, 14 were lost to follow up, 24 declined to participate, and 46 are still considering enrollment. Ultimately, 29 PVD patients enrolled and started using U-STEP for the collection of PROs. Approaching patients in clinic had a higher enrollment success rate as compared to mailing informational packets (19.6% vs 9.6%).

Conclusions: Understanding barriers and facilitators as well as employing successful patient enrollment strategies can improve the implementation of U-STEP in routine clinical practice. With more participants, future studies can better assess U-STEP’s utility in PVD management.