Part A: The Development of mI SMART: A Nurse-Led Technology Intervention for Multiple Chronic Conditions in Primary Care

Background: The treatment of Multiple Chronic Conditions (MCC) is complex for both patients and providers. Used as integrated tools, technology may decrease complexity, remove the barrier of distance to obtain care, and improve outcomes of care. A new platform that integrates multiple technologies for primary health care called mI SMART (Mobile Improvement of Self-Management Ability through Rural Technology) has been developed. The purpose of this paper is to present to development of mI SMART, a nurse-led technology intervention for treating for MCC in primary care. Methods: The creation of mI SMART was guided by the model for developing complex nursing interventions. The model suggests a process for building and informing interventions with the intention of effectiveness, sustainability, and scalability. Each step in the model builds from and informs the previous step. Results: The process resulted in the integrated technologies of mI SMART. The system combines a HIPAA compliant, web-based, structure of mHealth sensors and mobile devices to treat and monitor multiple chronic conditions within an existing free primary care clinic. The mI SMART system allows patients to track diagnoses, medications, lab results, receive reminders for self-management, perform self-monitoring, obtain feedback in real time, engage in education, and attend visits through video conferencing. The system displays a record database to patients and providers that will be integrated into existing Electronic Health Records. Conclusion: By using the model for developing complex nursing interventions, a multifaceted solution to clinical problems was identified. Through modeling and seeking expert review, we have established a sustainable and scalable integrated nurse-led intervention that may increase access and improve outcomes for patients living in rural and underserved areas. The first trial of mI SMART has been completed and evaluated for feasibility, acceptability, and effectiveness in persons in rural areas living with multiple chronic conditions.