Does Evergreen Life’s combination of digital personal health record with access to health services improve users’ health outcomes?
Problem
Digital services and personalised content can nudge people to change their health behaviours. This appears to be the case across countries, languages and for different aspects of health. This analysis aims to assess the link between the use of these digital services and observed health outcomes, using primary care record, app usage, and patient-level data from Evergreen Life.
Evergreen Life is a healthcare company that offers free app- and web-based Personal Health Record (PHR) solutions to over 850,000 users. A user’s PHR is comprised of: their Primary care record, which is retrieved from clinical systems through partnership with the NHS; patient reported outcome measures, which enable the user to record longitudinal momentary assessments (including self-reported measurements and wellness questionnaires), view relevant articles hosted on the Evergreen Life website, and encourage (“nudge”) users towards healthier lifestyles; Genetic data, from a paid-for DNA testing service, which enables users to make informed decisions about their lifestyles. In addition to the PHR patients can also access Digital Health Services such as appointment booking, repeat prescriptions and GP messaging.
Approach
To investigate the association between using Evergreen Life and objective health outcomes, two samples were constructed for Systolic Blood Pressure and HbA1c levels, respectively. We utilise the fact that many Evergreen Life users have measurements in their GP records that predate the creation of their Evergreen Life account. In each sample, only users whose blood pressures (>140/90 mmHg) and HbA1c levels (>42 mmol/mol) are initially high are included, to allow for analyses of the mean within-user change in measurements before and after their accounts were created. To supplement this, demographic and app usage data were included at the user level. Statistical models on both the mean change in measurements, and probability of returning to a normal range are analysed.
Findings
Preliminary results show significant reductions in both systolic Blood Pressure (-19.13 mmHg, p<0.001) and HbA1c levels (-2.49 mmol/mol, p<0.001) post-account creation. 65.3% of users’ mean systolic blood pressures reduced into the normal range (below 140 mmHg), and 26.8% of users’ HbA1c levels reduced into the normal range (below 42 mmol/mol). There is some heterogeneity in sub-groups of users: the oldest users show the largest reductions in blood pressure (aged 70+ years), and the reduction in mean HbA1c is only found amongst the least deprived users. Finally, users who access digital health services through the web-based version of Evergreen Life experience larger reductions in blood pressure than the App-based version.
Consequences
Digital PHRs that provide Health Services may have some effectiveness in improving the health outcomes considered above, but that this effect might be reduced in more deprived populations, and that the method of digital interaction could be a key factor in their effectiveness.