Physical capacity is one of the most important predictors of disability, mortality, and quality of life across many disease states, yet it is poorly captured in routine clinical care.  Traditional measures like office-based performance tests are underutilized because they are cumbersome to administer and may not approximate real-world conditions, while patient-reported physical status is an imprecise measure.  More importantly, our clinical informatics have traditionally not made this information readily accessible or valuable to the providers or the patient.  As a consequence, physical capacity is poorly documented and poorly utilized in clinical care.

Our project takes advantage of breakthroughs in digital health infrastructure and the proliferation of consumer wearable devices to capture patients’ physicalcapacity and make this data useful.  Duke established a portal that allows passive collection of Apple’s HealthKit data in the patients’ Epic health record.  We are providing patients admitted for COPD and CHF with Bluetooth enabled devices that transmit the patients’ daily step count passively to Epic. From this we will create patient-specific alerts that may serve as early warning signs of worsening health status.  These may offer opportunities to intervene, preventing costly and dangerous re-hospitalizations.

This project will establish the feasibility of such a post-discharge monitoring program, begin to demonstrate the optimal early-warning signal, and more generally show the promise of capturing physical activity in this novel way.  Next, we envision applications of this innovation to other diverse situations and disease states where objective measures of physical function add value.  Future research based on this groundwork may validate physical activity as an early warning sign, or even as a modifiable risk factor for poor outcomes.  Lastly, because the physical activity data will be collected in a way that is readily aggregated, this vast stream ofdata may form the basis of novel outcomes and effectiveness research.