title: Patient-Facing Mobile Apps to Treat High-Need, High-Cost Populations: A Scoping Review.
abstract: BACKGROUND
  Self-management is essential to caring for high-need, high-cost (HNHC) populations. Advances in mobile phone technology coupled with increased availability and adoption of health-focused mobile apps have made self-management more achievable, but the extent and quality of the literature supporting their use is not well defined.
  
  
  OBJECTIVE
  The purpose of this review was to assess the breadth, quality, bias, and types of outcomes measured in the literature supporting the use of apps targeting HNHC populations.
  
  
  METHODS
  Data sources included articles in PubMed and MEDLINE (National Center for Biotechnology Information), EMBASE (Elsevier), the Cochrane Central Register of Controlled Trials (EBSCO), Web of Science (Thomson Reuters), and the NTIS (National Technical Information Service) Bibliographic Database (EBSCO) published since 2008. We selected studies involving use of patient-facing iOS or Android mobile health apps. Extraction was performed by 1 reviewer; 40 randomly selected articles were evaluated by 2 reviewers to assess agreement.
  
  
  RESULTS
  Our final analysis included 175 studies. The populations most commonly targeted by apps included patients with obesity, physical handicaps, diabetes, older age, and dementia. Only 30.3% (53/175) of the apps studied in the reviewed literature were identifiable and available to the public through app stores. Many of the studies were cross-sectional analyses (42.9%, 75/175), small (median number of participants=31, interquartile range 11.0-207.2, maximum 11,690), or performed by an app's developers (61.1%, 107/175). Of the 175 studies, only 36 (20.6%, 36/175) studies evaluated a clinical outcome.
  
  
  CONCLUSIONS
  Most apps described in the literature could not be located on the iOS or Android app stores, and existing research does not robustly evaluate the potential of mobile apps. Whereas apps may be useful in patients with chronic conditions, data do not support this yet. Although we had 2-3 reviewers to screen and assess abstract eligibility, only 1 reviewer abstracted the data. This is one limitation of our study. With respect to the 40 articles (22.9%, 40/175) that were assigned to 2 reviewers (of which 3 articles were excluded), inter-rater agreement was significant on the majority of items (17 of 30) but fair-to-moderate on others.
authors.affiliation: Departments of Learning Health Sciences and Internal Medicine, University of Michigan Medical School, Ann Arbor, MI, United States.
authors.forename: Karandeep
authors.identifier: http://orcid.org/0000-0001-8980-2330
authors.initials: K
authors.lastname: Singh
authors.affiliation: Department of Pediatric Newborn Medicine, Brigham and Women's Hospital, Boston, MA, United States.
authors.forename: Kaitlin
authors.identifier: http://orcid.org/0000-0002-3514-3197
authors.initials: K
authors.lastname: Drouin
authors.affiliation: Information Systems, Partners HealthCare System, Wellesley, MA, United States.
authors.forename: Lisa P
authors.identifier: http://orcid.org/0000-0002-1492-2626
authors.initials: LP
authors.lastname: Newmark
authors.affiliation: University of Massachusetts Medical School, Worcester, MA, United States.
authors.forename: Malina
authors.identifier: http://orcid.org/0000-0002-9945-8518
authors.initials: M
authors.lastname: Filkins
authors.affiliation: Information Systems, Partners HealthCare System, Wellesley, MA, United States.
authors.forename: Elizabeth
authors.identifier: http://orcid.org/0000-0003-0300-9804
authors.initials: E
authors.lastname: Silvers
authors.affiliation: Harvard Medical School, Boston, MA, United States.
authors.forename: Paul A
authors.identifier: http://orcid.org/0000-0002-4257-2467
authors.initials: PA
authors.lastname: Bain
authors.affiliation: Division of General Medical Disciplines, Stanford University School of Medicine, Stanford, CA, United States.|Center for Innovation to Implementation, VA Palo Alto Health Care System, Menlo Park, CA, United States.
authors.forename: Donna M
authors.identifier: http://orcid.org/0000-0001-8904-2810
authors.initials: DM
authors.lastname: Zulman
authors.affiliation: Department of Emergency Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
authors.forename: Jae-Ho
authors.identifier: http://orcid.org/0000-0003-2619-1231
authors.initials: JH
authors.lastname: Lee
authors.affiliation: Harvard Medical School, Boston, MA, United States.|Division of General Internal Medicine, Brigham and Women's Hospital, Boston, MA, United States.
authors.forename: Ronen
authors.identifier: http://orcid.org/0000-0002-8503-5864
authors.initials: R
authors.lastname: Rozenblum
authors.affiliation: Harvard Medical School, Boston, MA, United States.|Division of General Internal Medicine, Brigham and Women's Hospital, Boston, MA, United States.
authors.forename: Erika
authors.identifier: http://orcid.org/0000-0003-3776-1754
authors.initials: E
authors.lastname: Pabo
authors.affiliation: Harvard Medical School, Boston, MA, United States.|Department of Emergency Medicine, Brigham and Women's Hospital, Boston, MA, United States.
authors.forename: Adam
authors.identifier: http://orcid.org/0000-0002-2166-0521
authors.initials: A
authors.lastname: Landman
authors.affiliation: Division of General Internal Medicine, Brigham and Women's Hospital, Boston, MA, United States.
authors.forename: Elissa V
authors.identifier: http://orcid.org/0000-0003-1311-0826
authors.initials: EV
authors.lastname: Klinger
authors.affiliation: Harvard Medical School, Boston, MA, United States.|Division of General Internal Medicine, Brigham and Women's Hospital, Boston, MA, United States.|Department of Health Policy and Management, Harvard TH Chan School of Public Health, Boston, MA, United States.
authors.forename: David W
authors.identifier: http://orcid.org/0000-0001-6268-1540
authors.initials: DW
authors.lastname: Bates
keywords: chronic disease; mHealth; mobile apps; review; self-management