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Sniderman J, Monarrez R, Drew J, Abdeen A. Mobile Application Use and Patient Engagement in Total Hip and Knee Arthroplasty. JBJS Rev 2024; 12:01874474-202402000-00003. [PMID: 38394327 DOI: 10.2106/jbjs.rvw.23.00208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/25/2024]
Abstract
» Mobile applications (MAs) are widely available for use during the perioperative period and are associated with increased adherence to rehabilitation plans, increased satisfaction with care, and considerable cost savings when used appropriately.» MAs offer surgeons and health care stakeholders the ability to collect clinical data and quality metrics that are important to value-based reimbursement models and clinical research.» Patients are willing to use wearable technology to assist with data collection as part of MAs but prefer it to be comfortable, easy to apply, and discreet.» Smart implants have been developed as the next step in MA use and data collection, but concerns exist pertaining to patient privacy and cost.» The ongoing challenge of MA standardization, validation, equity, and cost has persisted as concerns regarding widespread use.
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Affiliation(s)
- Jhase Sniderman
- Department of Orthopaedic Surgery, Boston Medical Center, Boston University Medical School, Boston, Massachusetts
- Section of Orthopaedic Surgery, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Ruben Monarrez
- Rubin Institute for Advanced Orthopedics, Center for Joint Preservation and Replacement, Sinai Hospital, Baltimore, Maryland
| | - Jacob Drew
- Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Ayesha Abdeen
- Department of Orthopaedic Surgery, Boston Medical Center, Boston University Medical School, Boston, Massachusetts
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Zhou Z, Zhou X, Cui N, Huang H, Yang F, Yang G, Liu D, Liu K, Zhang X, Wang J. Effectiveness of tele-rehabilitation after total hip replacement: a systematic review and meta-analysis of randomized controlled trials. Disabil Rehabil 2023:1-6. [PMID: 37990882 DOI: 10.1080/09638288.2023.2280070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Accepted: 11/01/2023] [Indexed: 11/23/2023]
Abstract
PURPOSE To identify articles that evaluated the efficacy of tele-rehabilitation after total hip replacement and to provide a reference for clinical decision-making and continuous improvement of rehabilitation exercise intervention strategies for clinical medical staff. METHODS Embase, PubMed, Web of Science, Medline, China National Knowledge Network and Google Scholar databases were searched for randomized controlled trials of tele-rehabilitation after total hip replacement from inception to March 4, 2023. The two researchers used the PEDro scale to assess the methodological quality of the included studies. Two researchers used the PEDro scale to assess the methodological quality of the included studies. RESULTS Ten studies with 632 participants were analysed.Compared to face-to-face rehabilitation, Internet-based telerehabilitation showed better outcomes in Get-up and go test (SMD -0.54, 95% CI -0.79 to -0.29). telerehabilitation showed no significant difference in outcomes of other functional tests and functional questionnaires. CONCLUSION In this systematic review and meta-analysis, internet-based tele-rehabilitation and face-to-face rehabilitation had the same effect on patients after total hip replacement, and compliance was higher in the tele-rehabilitation group, but attention should be devoted to standardizing this form of rehabilitation to avoid adverse events. In addition, the number and quality of included studies in this study are limited, and the outcome indicators and intervention means have not been unified. More high-quality studies are needed to verify these conclusions to better evaluate the effectiveness and advantages of telerehabilitation.Implications for rehabilitationWith the development of science and technology, remote rehabilitation technology will be applied to various fields of rehabilitation, providing personalized and extensive rehabilitation services.The application of tele-rehabilitation technology to postoperative rehabilitation after total hip arthroplasty is feasible and can reduce the workload of healthcare professionals to a certain extent.This review evaluated the randomized controlled trials of telerehabilitation after total hip arthroplasty, and the results showed that the clinical efficacy of telerehabilitation after total hip arthroplasty was not inferior to that of traditional rehabilitation.
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Affiliation(s)
- Zheng Zhou
- Department of Sports Medicine, Peking University Third Hospital, Institute of Sports Medicine of Peking University, Beijing, China
- Tianjin Key Laboratory of Exercise Physiology and Sports Medicine, Institute of Sport, Exercise & Health, Tianjin University of Sport, Tianjin, China
| | - Xiang Zhou
- Department of Sports Medicine, Peking University Third Hospital, Institute of Sports Medicine of Peking University, Beijing, China
| | - Na Cui
- Tianjin Key Laboratory of Exercise Physiology and Sports Medicine, Institute of Sport, Exercise & Health, Tianjin University of Sport, Tianjin, China
| | - Hongjie Huang
- Department of Sports Medicine, Peking University Third Hospital, Institute of Sports Medicine of Peking University, Beijing, China
| | - Fan Yang
- Department of Sports Medicine, Peking University Third Hospital, Institute of Sports Medicine of Peking University, Beijing, China
| | - Gang Yang
- Department of Sports Medicine, Peking University Third Hospital, Institute of Sports Medicine of Peking University, Beijing, China
| | - Dingge Liu
- Department of Sports Medicine, Peking University Third Hospital, Institute of Sports Medicine of Peking University, Beijing, China
| | - Kaiping Liu
- Department of Sports Medicine, Peking University Third Hospital, Institute of Sports Medicine of Peking University, Beijing, China
| | - Xin Zhang
- Department of Sports Medicine, Peking University Third Hospital, Institute of Sports Medicine of Peking University, Beijing, China
| | - Jianquan Wang
- Department of Sports Medicine, Peking University Third Hospital, Institute of Sports Medicine of Peking University, Beijing, China
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McLean KA, Knight SR, Diehl TM, Varghese C, Ng N, Potter MA, Zafar SN, Bouamrane MM, Harrison EM. Readiness for implementation of novel digital health interventions for postoperative monitoring: a systematic review and clinical innovation network analysis. Lancet Digit Health 2023; 5:e295-e315. [PMID: 37100544 DOI: 10.1016/s2589-7500(23)00026-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Revised: 02/01/2023] [Accepted: 02/03/2023] [Indexed: 04/28/2023]
Abstract
An increasing number of digital health interventions (DHIs) for remote postoperative monitoring have been developed and evaluated. This systematic review identifies DHIs for postoperative monitoring and evaluates their readiness for implementation into routine health care. Studies were defined according to idea, development, exploration, assessment, and long-term follow-up (IDEAL) stages of innovation. A novel clinical innovation network analysis used coauthorship and citations to examine collaboration and progression within the field. 126 DHIs were identified, with 101 (80%) being early stage innovations (IDEAL stage 1 and 2a). None of the DHIs identified had large-scale routine implementation. There is little evidence of collaboration, and there are clear omissions in the evaluation of feasibility, accessibility, and the health-care impact. Use of DHIs for postoperative monitoring remains at an early stage of innovation, with promising but generally low-quality supporting evidence. Comprehensive evaluation within high-quality, large-scale trials and real-world data are required to definitively establish readiness for routine implementation.
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Affiliation(s)
- Kenneth A McLean
- Centre for Medical Informatics, Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Stephen R Knight
- Centre for Medical Informatics, Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Thomas M Diehl
- Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Chris Varghese
- Department of Surgery, University of Auckland, Auckland, New Zealand
| | - Nathan Ng
- Centre for Medical Informatics, Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Mark A Potter
- Colorectal Unit, Western General Hospital, Edinburgh, UK
| | - Syed Nabeel Zafar
- Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Matt-Mouley Bouamrane
- Centre for Medical Informatics, Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Ewen M Harrison
- Centre for Medical Informatics, Usher Institute, University of Edinburgh, Edinburgh, UK.
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Remote Patient Monitoring Following Total Joint Arthroplasty. Orthop Clin North Am 2023; 54:161-168. [PMID: 36894289 DOI: 10.1016/j.ocl.2022.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/11/2023]
Abstract
This review article presents the current state of remote patient monitoring (RPM) in total joint arthroplasty. RPM refers to the use of telecommunication with wearable and implantable technology to assess and treat patients. Several forms of RPM are discussed including telemedicine, patient engagement platforms, wearable devices, and implantable devices. The benefits to patients and physicians are discussed in the context of postoperative monitoring. Insurance coverage and reimbursement of these technologies are reviewed.
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Hansjee S, Giebaly DE, Shaarani SR, Haddad FS. Follow-up after arthroplasty surgery : a changing landscape. Bone Joint J 2022; 104-B:1104-1109. [PMID: 36177643 DOI: 10.1302/0301-620x.104b10.bjj-2022-0311.r1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
We aim to explore the potential technologies for monitoring and assessment of patients undergoing arthroplasty by examining selected literature focusing on the technology currently available and reflecting on possible future development and application. The reviewed literature indicates a large variety of different hardware and software, widely available and used in a limited manner, to assess patients' performance. There are extensive opportunities to enhance and integrate the systems which are already in existence to develop patient-specific pathways for rehabilitation.Cite this article: Bone Joint J 2022;104-B(10):1104-1109.
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Affiliation(s)
- Shanil Hansjee
- University College London Hospitals NHS Foundation Trust, London, UK
| | - Dia E Giebaly
- University College London Hospitals NHS Foundation Trust, London, UK
| | | | - Fares S Haddad
- University College London Hospitals NHS Foundation Trust, London, UK.,The Bone & Joint Journal, London, UK
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Knapp PW, Keller RA, Mabee KA, Shi J, Pillai R, Frisch NB. Comparison of a Smartphone App to Manual Knee Range of Motion Measurements. Arthroplast Today 2022; 15:43-46. [PMID: 35399987 PMCID: PMC8987335 DOI: 10.1016/j.artd.2021.09.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Revised: 08/30/2021] [Accepted: 09/07/2021] [Indexed: 11/19/2022] Open
Abstract
Background Digital technology has emerged as a useful tool for preoperative and postoperative patient engagement and for remote patient monitoring. Smartphones are equipped with motion-sensing technology, and apps can be designed which use these features to create a simple method for measuring range of motion. The purpose of this study was to determine the accuracy of digital technology in assessing knee range of motion using a smartphone app, compared to traditional goniometric measurements in an office setting. Methods Fifty-three (53) patients in a clinical practice were enrolled between October 2019 and March 2020. Three separate measurements were taken during the patient encounter: (1) the surgeon, (2) the app, and (3) the physical therapist. Intraclass correlations were computed to assess the agreement between (1) the surgeon and app and (2) that between the physical therapist and surgeon. Results When measuring flexion, the correlation between either the surgeon or therapist with the app was good, whereas the comparison between the surgeon and therapist was moderate. All extension measurement comparisons, between the app, surgeon, and therapist, showed moderate correlation. Limits of agreements showed that 80% of the difference between surgeon and app is within 10 degrees for extension and 11 degrees for flexion. Body mass index did not affect the accuracy of the measurements. Conclusion Digital app measurements were comparable to measurements made by either a surgeon or physical therapist with a manual goniometer in the clinical setting and may be beneficial for measuring and monitoring patients’ range of motion remotely.
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Farrell RM, Pierce M, Collart C, Yao M, Coleridge M, Chien EK, Rose SS, Lintel M, Perni U, Edmonds BT. Decision-making for prenatal genetic screening: how will pregnant women navigate a growing number of aneuploidy and carrier screening options? BMC Pregnancy Childbirth 2021; 21:806. [PMID: 34863134 PMCID: PMC8642756 DOI: 10.1186/s12884-021-04282-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Accepted: 11/02/2021] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Prenatal genetic screens, including carrier screening (CS) and aneuploidy screening (AS), comprise an important component of reproductive healthcare delivery. Clinical practice guidelines emphasize the importance of informed decision-making and patient's preferences regarding the use of these screens. Yet, it is unclear how to achieve this ideal as prenatal genetic screening options rapidly become more complex and increasingly available to patients. With increased complexity and availability of reproductive testing options, decision-support strategies are critical to prepare patients to consider AS and/or CS. METHODS A self-administered survey evaluated knowledge and decision-making preferences for expanded carrier (CS) and aneuploidy (AS) prenatal screening. The survey was administered to participants before their first prenatal visit to assess baseline decision-making needs and preference at the initiation of prenatal care. Analysis was approached as a descriptive process. RESULTS Participants had similar familiarity with the concepts associated with AS compared to CS; mean knowledge scores for CS was 0.59 [possible range 0.00 to 1.00] and 0.55 for AS. Participants reported preferences to learn about a range of conditions, including those with severe or mild impact, childhood-onset, and adult-onset. Decision-making preference with respect to learning about the associated disease phenotypes for the contained on AS and CS panel shifted with the complexity of the panel, with a greater preference to learn about conditions post-test compared pre-test education as panels increased from 5 to 100 conditions. CONCLUSION Patients' baseline knowledge of prenatal genetic screens coupled with evolving decision-making preferences presents challenges for the delivery of prenatal genetic screens. This calls for the development and implementation of innovative approaches to support pregnant patients' decision-making commensurate with advances in prenatal genomics.
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Affiliation(s)
- Ruth M Farrell
- OB/GYN and Women's Health Institute, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH, 44195, USA.
- Genomic Medicine Institute, Cleveland Clinic, Cleveland, OH, USA.
- Center for Bioethics, Cleveland Clinic, Cleveland, OH, USA.
| | - Madelyn Pierce
- OB/GYN and Women's Health Institute, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH, 44195, USA
| | - Christina Collart
- OB/GYN and Women's Health Institute, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH, 44195, USA
| | - Meng Yao
- Quantitative Health Science Department, Cleveland Clinic, Cleveland, OH, USA
| | - Marissa Coleridge
- OB/GYN and Women's Health Institute, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH, 44195, USA
- Genomic Medicine Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Edward K Chien
- OB/GYN and Women's Health Institute, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH, 44195, USA
| | - Susannah S Rose
- Office of Patient Experience, Clinical Transformation, Cleveland Clinic, Cleveland, OH, USA
| | - Mary Lintel
- OB/GYN and Women's Health Institute, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH, 44195, USA
| | - Uma Perni
- OB/GYN and Women's Health Institute, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH, 44195, USA
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Holte AJ, Molloy IB, Werth PM, Jevsevar DS. Do Patient Engagement Platforms in Total Joint Arthroplasty Improve Patient-Reported Outcomes? J Arthroplasty 2021; 36:3850-3858. [PMID: 34481693 DOI: 10.1016/j.arth.2021.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Revised: 06/16/2021] [Accepted: 08/02/2021] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Web-based patient engagement portals are increasing in popularity after total hip and knee arthroplasty (THA and TKA). The literature is mixed regarding patient utilization of these modalities and potential clinical benefit. We sought to determine which demographic factors are associated with increased platform participation and to quantify the impact of a web-based patient portal on patient-reported outcome measures (PROMs). METHODS We performed a retrospective analysis of consecutive primary THA (n = 554) and TKA (n = 485) at a single academic institution with minimum follow-up of 12 months. Patients were divided into those who opted-in and those who opted-out of portal use. Global health and joint-specific PROMs were collected preoperatively and postoperatively. Linear mixed effects modeling, bivariate analysis, and logistic regression were utilized. RESULTS Of the 1039 included patients, 60.6% (336) THA and 62.7% (304) TKA patients enrolled in the portal. Those who opted-in were younger (P < .001, P < .003), had higher body mass index (P = .024, P = .011), and had a higher household income (P < .001, P < .001) in THA and TKA cohorts, respectively. Portal participation in the TKA but not the THA cohort was associated with significant improvement in physical function (P = .017) and joint-specific function (P = .045). For THA patients who opted-in, increased portal logins were associated with more rapid improvement and higher functional scores (P = .013). CONCLUSION There is an inherent difference between patients who opt-in to and those who opt-out of web-based portals. Added resources and support provided by portals may translate to improved PROMs for TKA patients but not THA patients.
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Affiliation(s)
- Andrew J Holte
- Department of Orthopedics, Dartmouth-Hitchcock Medical Center, One Medical Center Dr., Lebanon, NH
| | - Ilda B Molloy
- Department of Orthopedics, Dartmouth-Hitchcock Medical Center, One Medical Center Dr., Lebanon, NH
| | - Paul M Werth
- Department of Orthopedics, Dartmouth-Hitchcock Medical Center, One Medical Center Dr., Lebanon, NH
| | - David S Jevsevar
- Department of Orthopedics, Dartmouth-Hitchcock Medical Center, One Medical Center Dr., Lebanon, NH
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Dawson NL, Hull BP, Vijapura P, Dumitrascu AG, Ball CT, Thiemann KM, Maniaci MJ, Burton MC. Home Telemonitoring to Reduce Readmission of High-Risk Patients: a Modified Intention-to-Treat Randomized Clinical Trial. J Gen Intern Med 2021; 36:3395-3401. [PMID: 33506388 PMCID: PMC8606403 DOI: 10.1007/s11606-020-06589-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Accepted: 12/30/2020] [Indexed: 12/19/2022]
Abstract
BACKGROUND Home telemonitoring has been used with discharged patients in an attempt to reduce 30-day readmissions with mixed results. OBJECTIVE To assess whether home 30-day telemonitoring after discharge for patients at high risk of readmission would reduce readmissions or mortality. DESIGN Prospective, randomized controlled trial. PATIENTS We compared 30-day readmission rates and mortality for patients at high risk for readmission who received home telemonitoring versus standard care between November 1, 2014, and November 30, 2018, in 2 tertiary care hospitals. INTERVENTIONS The intervention group received home-installed equipment to measure blood pressure, heart rate, pulse oximetry, weight if heart failure was present, and glucose if diabetes was present. Results were transmitted daily and reviewed by a nurse. Both groups received standard care. MAIN MEASURES The primary outcome was a composite end point of hospital readmission or death within 30 days after discharge. The secondary outcome was an emergency department visit within 30 days after discharge. KEY RESULTS A total of 1380 participants (mean [SD] age, 66 [14] years; 722 [52.3%] men and 658 [47.7%] women) participated in this study. Using a modified intention-to-treat analysis, the risk of readmission or death within 30 days among patients at high readmission risk was 23.7% (137/578) in the control group and 18.2% (87/477) in the telemonitoring group (absolute risk difference, - 5.5% [95% CI, - 10.4 to - 0.6%]; relative risk, 0.77 [95% CI, 0.61 to 0.98]; P = .03). Emergency department visits occurred within 30 days after discharge in 14.2% (81/570) of patients in the control group and 8.6% (40/464) of patients in the telemonitoring group (absolute risk difference, - 5.6% [95% CI, - 9.4 to - 1.8%]; relative risk, 0.61 [95% CI, 0.42 to 0.87]; P = .005). CONCLUSIONS Thirty days of postdischarge telemonitoring may reduce readmissions of high-risk patients. TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT02136186.
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Affiliation(s)
- Nancy L Dawson
- Division of Hospital Internal Medicine, Mayo Clinic, 4500 San Pablo Rd, Jacksonville, FL, 32224, USA.
| | - Bryan P Hull
- Division of Hospital Internal Medicine, Mayo Clinic Hospital, Phoenix, AZ, USA
| | - Priyanka Vijapura
- Division of Hospital Internal Medicine, Mayo Clinic, 4500 San Pablo Rd, Jacksonville, FL, 32224, USA
| | - Adrian G Dumitrascu
- Division of Hospital Internal Medicine, Mayo Clinic, 4500 San Pablo Rd, Jacksonville, FL, 32224, USA
| | - Colleen T Ball
- Department of Health Sciences Research, Mayo Clinic, Jacksonville, FL, USA
| | - Kay M Thiemann
- Shared Services Administration, Mayo Clinic, Rochester, MN, USA
| | - Michael J Maniaci
- Division of Hospital Internal Medicine, Mayo Clinic, 4500 San Pablo Rd, Jacksonville, FL, 32224, USA
| | - M Caroline Burton
- Division of Hospital Internal Medicine, Mayo Clinic, Rochester, MN, USA
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Mashhadi SF, Hisam A, Sikander S, Rathore MA, Rifaq F, Khan SA, Hafeez A. Post Discharge mHealth and Teach-Back Communication Effectiveness on Hospital Readmissions: A Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph181910442. [PMID: 34639741 PMCID: PMC8508113 DOI: 10.3390/ijerph181910442] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Revised: 09/25/2021] [Accepted: 09/27/2021] [Indexed: 12/12/2022]
Abstract
Hospital readmissions pose a threat to the constrained health resources, especially in resource-poor low-and middle-income countries. In such scenarios, appropriate technologies to reduce avoidable readmissions in hospitals require innovative interventions. mHealth and teach-back communication are robust interventions, utilized for the reduction in preventable hospital readmissions. This review was conducted to highlight the effectiveness of mHealth and teach-back communication in hospital readmission reduction with a view to provide the best available evidence on such interventions. Two authors independently searched for appropriate MeSH terms in three databases (PubMed, Wiley, and Google Scholar). After screening the titles and abstracts, shortlisted manuscripts were subjected to quality assessment and analysis. Two authors checked the manuscripts for quality assessment and assigned scores utilizing the QualSyst tool. The average of the scores assigned by the reviewers was calculated to assign a summary quality score (SQS) to each study. Higher scores showed methodological vigor and robustness. Search strategies retrieved a total of 1932 articles after the removal of duplicates. After screening titles and abstracts, 54 articles were shortlisted. The complete reading resulted in the selection of 17 papers published between 2002 and 2019. Most of the studies were interventional and all the studies focused on hospital readmission reduction as the primary or secondary outcome. mHealth and teach-back communication were the two most common interventions that catered for the hospital readmissions. Among mHealth studies (11 out of 17), seven studies showed a significant reduction in hospital readmissions while four did not exhibit any significant reduction. Among the teach-back communication group (6 out of 17), the majority of the studies (5 out of 6) showed a significant reduction in hospital readmissions while one publication did not elicit a significant hospital readmission reduction. mHealth and teach-back communication methods showed positive effects on hospital readmission reduction. These interventions can be utilized in resource-constrained settings, especially low- and middle-income countries, to reduce preventable readmissions.
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Affiliation(s)
- Syed Fawad Mashhadi
- Department of Community Medicine, Army Medical College, National University of Medical Sciences, Rawalpindi 46000, Pakistan; (A.H.); (M.A.R.)
- Department of Public Health, Health Services Academy, Opposite National Institute of Health, Islamabad 44000, Pakistan
- Correspondence:
| | - Aliya Hisam
- Department of Community Medicine, Army Medical College, National University of Medical Sciences, Rawalpindi 46000, Pakistan; (A.H.); (M.A.R.)
| | - Siham Sikander
- Global Health Department, Health Services Academy, Opposite National Institute of Health, Islamabad 44000, Pakistan;
- Institute of Population Health, University of Liverpool, Liverpool L69 3BX, UK
| | - Mommana Ali Rathore
- Department of Community Medicine, Army Medical College, National University of Medical Sciences, Rawalpindi 46000, Pakistan; (A.H.); (M.A.R.)
| | - Faisal Rifaq
- Sehat Sahulat Program, Ministry of National Health Services, Regulations and Coordination, Government of Pakistan, Hall 3A, 3rd Floor, Kohsar Block, Pak Secretariat, Islamabad 44000, Pakistan;
| | - Shahzad Ali Khan
- Health Services Academy, Opposite National Institute of Health, Islamabad 44000, Pakistan; (S.A.K.); (A.H.)
| | - Assad Hafeez
- Health Services Academy, Opposite National Institute of Health, Islamabad 44000, Pakistan; (S.A.K.); (A.H.)
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Knapp PW, Keller RA, Mabee KA, Pillai R, Frisch NB. Quantifying Patient Engagement in Total Joint Arthroplasty Using Digital Application-Based Technology. J Arthroplasty 2021; 36:3108-3117. [PMID: 33965282 DOI: 10.1016/j.arth.2021.04.022] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Revised: 04/12/2021] [Accepted: 04/16/2021] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Digital patient engagement has been suggested as a mean to increase patient activation and patient satisfaction after total joint arthroplasty. The purpose of this study was to assess patient engagement with application-based educational tools and to explore what content was most useful to patients in the perioperative period surrounding total hip arthroplasty (THA) and total knee arthroplasty (TKA), respectively. METHODS Patients undergoing THA and TKA between October 2017 and January 2020 were enrolled to use an application-based digital technology. The App provides comprehensive patient education using a series of modules delivered at set intervals preoperatively and postoperatively. Patient engagement was defined as patients viewing at least one time the modules that were sent, or marking them as completed. Patient satisfaction was assessed using an in-application survey. RESULTS Complete data were available on 207 patients of which 95 (46%) underwent THA and 112 (54%) underwent TKA. The average age was 60 years. 54% with patients invited to the program completed registration. An average compliance rate of 48% (41 modules engaged out of 83) was observed. Of all modules completed, the top three most popular categories included physical therapy/exercise videos, health literacy, and anxiety/stress/pain management. The least viewed category was nutrition planning and education. CONCLUSION When presented educational material related to THA and TKA, patients had a high rate of compliance. Digital technology platforms provide a scalable, meaningful approach to engaging patients throughout the continuum of joint replacement care and may serve as a cost-effective adjunct to traditional methods.
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Affiliation(s)
- Paul W Knapp
- Orthopaedic Surgery, Ascension Macomb-Oakland Hospital, Madison Heights, MI
| | - Robert A Keller
- Orthopaedic Surgery, Ascension Providence Rochester Hospital, Rochester, MI
| | - Kathryn A Mabee
- Orthopaedic Surgery, Ascension Providence Rochester Hospital, Rochester, MI
| | - Raji Pillai
- Medical Affairs Consulting, Inc, San Francisco, CA
| | - Nicholas B Frisch
- Orthopaedic Surgery, Ascension Providence Rochester Hospital, Rochester, MI
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12
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Rhind JH, Devany A, Ramhamadany E, Ismael S, Heaver C, Hill S. Virtual clinics in foot and ankle surgery: patient and clinician perceptions. Ann R Coll Surg Engl 2021; 103:666-672. [PMID: 34432532 DOI: 10.1308/rcsann.2020.7147] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND The worldwide COVID-19 pandemic has led to the popularisation of 'virtual' clinics. In orthopaedics, little is known about the use of virtual clinics within foot and ankle surgery, specifically. METHODS A cross-sectional observation study of patients and clinicians in response to virtual clinics in foot and ankle surgery. Patients seen in a virtual clinic were contacted by telephone from two weeks after their consultation and asked to complete a 12-point questionnaire. Demographic information was also collected. Clinicians in foot and ankle completed a 10-point questionnaire. RESULTS One hundred patient responses were collected. Patient satisfaction with virtual clinics was positive, with 65% of respondents reporting they were very happy (Likert scale rating 5). More than 90% of patients felt they received enough information, felt involved, felt the virtual clinic was helpful and knew who to contact if there was a problem. However, 79% would still prefer a face-to-face consultation, and 22% would have preferred a video consultation. Clinician responses were more cautious, with 60% stating they were neither happy nor unhappy (Likert scale rating 3). Virtual clinics may be faster for the clinician. CONCLUSIONS Virtual clinics may be more convenient for patients, with high satisfaction levels reported, but represent significant clinical challenges for foot and ankle surgeons. Elements of virtual clinics may persist post pandemic, particularly in routine follow-up. Virtual clinics are not appropriate for new patient referrals.
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Affiliation(s)
- J-H Rhind
- The Robert Jones Agnes Hunt Orthopaedic Hospital NHS Foundation Trust, UK
| | - A Devany
- The Robert Jones Agnes Hunt Orthopaedic Hospital NHS Foundation Trust, UK
| | - E Ramhamadany
- The Robert Jones Agnes Hunt Orthopaedic Hospital NHS Foundation Trust, UK
| | - S Ismael
- The Robert Jones Agnes Hunt Orthopaedic Hospital NHS Foundation Trust, UK
| | - C Heaver
- The Robert Jones Agnes Hunt Orthopaedic Hospital NHS Foundation Trust, UK
| | - S Hill
- The Robert Jones Agnes Hunt Orthopaedic Hospital NHS Foundation Trust, UK
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13
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Zanotto BS, Etges APBDS, Marcolino MAZ, Polanczyk CA. Value-Based Healthcare Initiatives in Practice: A Systematic Review. J Healthc Manag 2021; 66:340-365. [PMID: 34192716 PMCID: PMC8423138 DOI: 10.1097/jhm-d-20-00283] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
EXECUTIVE SUMMARY Value-based initiatives are growing in importance as strategic models of healthcare management, prompting the need for an in-depth exploration of their outcome measures. This systematic review aimed to identify measures that are being used in the application of the value agenda. Multiple electronic databases (PubMed/MEDLINE, Embase, Scopus, Cochrane Central Register of Controlled Trials) were searched. Eligible studies reported various implementations of value-based healthcare initiatives. A qualitative approach was used to analyze their outcome measurements. Outcomes were classified according to a tier-level hierarchy. In a radar chart, we compared literature to cases from Harvard Business Publishing. The value agenda effect reported was described in terms of its impact on each domain of the value equation. A total of 7,195 records were retrieved; 47 studies were included. Forty studies used electronic health record systems for data origin. Only 16 used patient-reported outcome surveys to cover outcome tiers that are important to patients, and 3 reported outcomes to all 6 levels of our outcome measures hierarchy. A considerable proportion of the studies (36%) reported results that contributed to value-based financial outcomes focused on cost savings. However, a gap remains in measuring outcomes that matter to patients. A more complete application of the value agenda by health organizations requires advances in technology and culture change management.
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Affiliation(s)
- Bruna Stella Zanotto
- National Institute of Health Technology Assessment and Graduate Program in Epidemiology, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Ana Paula Beck da Silva Etges
- National Institute of Health Technology Assessment, Federal University of Rio Grande do Sul, and Pontifical Catholic University of Rio Grande do Sul Polytechnic School, Porto Alegre, Brazil
| | - Miriam Allein Zago Marcolino
- National Institute of Health Technology Assessment, Federal University of Rio Grande do Sul and Graduate Program in Epidemiology, Federal University of Rio Grande do Sul; and
| | - Carisi Anne Polanczyk
- National Institute of Health Technology Assessment, Federal University of Rio Grande do Sul, and Graduate Programs in Epidemiology and Cardiology and Cardiovascular Sciences, Federal University of Rio Grande do Sul
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14
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Patient Engagement Technologies in Orthopaedics: What They Are, What They Offer, and Impact. J Am Acad Orthop Surg 2021; 29:e584-e592. [PMID: 33826580 DOI: 10.5435/jaaos-d-20-00585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Accepted: 12/06/2020] [Indexed: 02/01/2023] Open
Abstract
The modern era is an increasingly digital and connected world. Most of the Americans now use a smartphone irrespective of age or income level. As smartphone technologies become ubiquitous, there is tremendous interest and growth in mobile health applications. One segment of these new technologies are the so-called patient engagement platforms. These technologies present a host of features that may improve care. This article provides an introduction to this growing technology sector, offers insight into what they may offer patients and surgeons, and discusses how to evaluate various platforms.
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15
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Tsang C, Lee KS, Richards H, Blazeby JM, Avery KNL. Electronic collection of patient-reported outcomes following discharge after surgery: systematic review. BJS Open 2021; 5:6199902. [PMID: 33782708 PMCID: PMC8007587 DOI: 10.1093/bjsopen/zraa072] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2020] [Accepted: 12/09/2020] [Indexed: 12/16/2022] Open
Abstract
Background Little is known about the electronic collection and clinical feedback of patient-reported outcomes (ePROs) following surgical discharge. This systematic review summarized the evidence on the collection and uses of electronic systems to collect PROs after discharge from hospital after surgery. Method Systematic searches of MEDLINE, Embase, PsycINFO, CINAHL and Cochrane Central were undertaken from database inception to July 2019 using terms for ‘patient reported outcomes’, ‘electronic’, ‘surgery’ and ‘at home’. Primary research of all study designs was included if they used electronic systems to collect PRO data in adults after hospital discharge following surgery. Data were collected on the settings, patient groups and specialties, ePRO systems (including features and functions), PRO data collected, and integration with health records. Results Fourteen studies were included from 9474 records, including two RCTs and six orthopaedic surgery studies. Most studies (9 of 14) used commercial ePRO systems. Six reported types of electronic device were used: tablets or other portable devices (3 studies), smartphones (2), combination of smartphones, tablets, portable devices and computers (1). Systems had limited features and functions such as real-time clinical feedback (6 studies) and messaging service for patients with care teams (3). No study described ePRO system integration with electronic health records to support clinical feedback. Conclusion There is limited reporting of ePRO systems in the surgical literature, and ePRO systems lack integration with hospital clinical systems. Future research should describe the ePRO system and ePRO questionnaires used, and challenges encountered during the study, to support efficient upscaling of ePRO systems using tried and tested approaches.
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Affiliation(s)
- C Tsang
- Bristol Centre for Surgical Research, Bristol Medical School: Population Health Sciences, University of Bristol, Bristol, UK
| | - K S Lee
- Bristol Medical School, University of Bristol, Bristol, UK
| | - H Richards
- Bristol Centre for Surgical Research, Bristol Medical School: Population Health Sciences, University of Bristol, Bristol, UK
| | - J M Blazeby
- Bristol Centre for Surgical Research, Bristol Medical School: Population Health Sciences, University of Bristol, Bristol, UK.,Division of Surgery, Head and Neck, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
| | - K N L Avery
- Bristol Centre for Surgical Research, Bristol Medical School: Population Health Sciences, University of Bristol, Bristol, UK
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16
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Windsor EN, Sharma AK, Gkiatas I, Elbuluk AM, Sculco PK, Vigdorchik JM. An Overview of Telehealth in Total Joint Arthroplasty. HSS J 2021; 17:51-58. [PMID: 33967642 PMCID: PMC8077983 DOI: 10.1177/1556331620972629] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Accepted: 10/06/2020] [Indexed: 12/13/2022]
Abstract
With the increase in technological advances over the years, telehealth services in orthopedic surgery have gained in popularity, yet adoption among surgeons has been slow. With the onset of the COVID-19 pandemic, however, orthopedic surgery practices nationwide have accelerated adaptation to telemedicine. Telehealth can be effectively applied to total joint arthroplasty, with the ability to perform preoperative consultations, postoperative follow-up, and telerehabilitation in a virtual, remote manner with similar outcomes to in-person visits. New technologies that have emerged, such as virtual goniometers, wearable sensors, and app-based patient questionnaires, have improved clinicians' ability to conduct telehealth visits. Benefits of using telehealth include high patient satisfaction, cost-savings, increased access to care, and more efficiency. Notably, some challenges still exist, including widespread accessibility and adaptation of new technologies, inability to conduct an in-person orthopedic physical examination, and regulatory barriers, such as insurance reimbursement, increased medicolegal risk, and privacy and confidentiality concerns. Despite these hurdles, telehealth is here to stay and can be successfully incorporated in any total joint arthroplasty practice with the appropriate adjustments.
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Affiliation(s)
- Eric N. Windsor
- Adult Reconstruction and Joint Replacement Service, Hospital for Special Surgery, New York, NY, USA
| | - Abhinav K. Sharma
- Adult Reconstruction and Joint Replacement Service, Hospital for Special Surgery, New York, NY, USA
| | - Ioannis Gkiatas
- Stavros Niarchos Foundation Complex Joint Reconstruction Center, Hospital for Special Surgery, New York, NY, USA
| | - Ameer M. Elbuluk
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY, USA
| | - Peter K. Sculco
- Stavros Niarchos Foundation Complex Joint Reconstruction Center, Hospital for Special Surgery, New York, NY, USA
| | - Jonathan M. Vigdorchik
- Adult Reconstruction and Joint Replacement Service, Hospital for Special Surgery, New York, NY, USA
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17
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Baumann AP, O'Neill C, Owens MC, Weber SC, Sivan S, D'Amico R, Carmody S, Bini S, Sawyer AJ, Lotz JC, Goel V, Dmitriev AE. FDA public workshop: Orthopaedic sensing, measuring, and advanced reporting technology (SMART) devices. J Orthop Res 2021; 39:22-29. [PMID: 32827329 DOI: 10.1002/jor.24833] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Revised: 08/10/2020] [Accepted: 08/18/2020] [Indexed: 02/04/2023]
Abstract
Traditional orthopaedic devices do not communicate with physicians or patients post-operatively. After implantation, follow-up of traditional orthopaedic devices is generally limited to episodic monitoring. However, the orthopaedic community may be shifting towards incorporation of smart technology. Smart technology in orthopaedics is a term that encompasses a wide range of potential applications. Smart orthopaedic implants offer the possibility of gathering data and exchanging it with an external reader. They incorporate technology that enables automated sensing, measuring, processing, and reporting of patient or device parameters at or near the implant. While including advanced technology in orthopaedic devices has the potential to benefit patients, physicians, and the scientific community, it may also increase the patient risks associated with the implants. Understanding the benefit-risk profile of new smart orthopaedic devices is critical to ensuring their safety and effectiveness. The 2018 FDA public workshop on orthopaedic sensing, measuring, and advanced reporting technology (SMART) devices was held on April 30, 2018, at the FDA White Oak Campus in Silver Spring, MD with the goal of fostering a collaborative dialogue amongst the orthopaedic community. Workshop attendees discussed four key areas related to smart orthopaedic devices: engineering and technology considerations, clinical and patient perspectives, cybersecurity, and regulatory considerations. The workshop presentations and associated discussions highlighted the need for the orthopaedic community to collectively craft a responsible path for incorporating smart technology in musculoskeletal disease care.
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Affiliation(s)
- Andrew P Baumann
- Center for Devices and Radiological Health, U.S. Food and Drug Administration, Silver Spring, Maryland
| | - Colin O'Neill
- Center for Devices and Radiological Health, U.S. Food and Drug Administration, Silver Spring, Maryland
| | - Michael C Owens
- Center for Devices and Radiological Health, U.S. Food and Drug Administration, Silver Spring, Maryland
| | - Stephen C Weber
- Center for Devices and Radiological Health, U.S. Food and Drug Administration, Silver Spring, Maryland
| | - Shiril Sivan
- Center for Devices and Radiological Health, U.S. Food and Drug Administration, Silver Spring, Maryland
| | - Reid D'Amico
- American Institute of Medical and Biological Engineering (AIMBE) Scholar, Center for Devices and Radiological Health, U.S. Food and Drug Administration, Silver Spring, Maryland
| | - Seth Carmody
- Center for Devices and Radiological Health, U.S. Food and Drug Administration, Silver Spring, Maryland
| | - Stefano Bini
- Department of Orthopaedic Surgery, University of California, San Francisco (UCSF), San Francisco, California
| | - Aenor J Sawyer
- Department of Orthopaedic Surgery, University of California, San Francisco (UCSF), San Francisco, California
| | - Jeffrey C Lotz
- Department of Orthopaedic Surgery, University of California, San Francisco (UCSF), San Francisco, California
| | - Vijay Goel
- Departments of Bioengineering and Orthopaedic Surgery, Colleges of Engineering and Medicine, University of Toledo, Toledo, Ohio
| | - Anton E Dmitriev
- Center for Devices and Radiological Health, U.S. Food and Drug Administration, Silver Spring, Maryland
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18
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Mehta SJ, Hume E, Troxel AB, Reitz C, Norton L, Lacko H, McDonald C, Freeman J, Marcus N, Volpp KG, Asch DA. Effect of Remote Monitoring on Discharge to Home, Return to Activity, and Rehospitalization After Hip and Knee Arthroplasty: A Randomized Clinical Trial. JAMA Netw Open 2020; 3:e2028328. [PMID: 33346847 PMCID: PMC7753899 DOI: 10.1001/jamanetworkopen.2020.28328] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Accepted: 10/10/2020] [Indexed: 12/13/2022] Open
Abstract
Importance Hip and knee arthroplasty are the most common inpatient surgical procedures for Medicare beneficiaries in the US, with substantial variation in cost and quality. Whether remote monitoring incorporating insights from behavioral science might help improve outcomes and increase value of care remains unknown. Objective To evaluate the effect of activity monitoring and bidirectional text messaging on the rate of discharge to home and clinical outcomes in patients receiving hip or knee arthroplasty. Design, Setting, and Participants Randomized clinical trial conducted between February 7, 2018, and April 15, 2019. The setting was 2 urban hospitals at an academic health system. Participants were patients aged 18 to 85 years scheduled to undergo hip or knee arthroplasty with a Risk Assessment and Prediction Tool score of 6 to 8. Interventions Eligible patients were randomized evenly to receive usual care (n = 153) or remote monitoring (n = 147). Those in the intervention arm who agreed received a wearable activity monitor to track step count, messaging about postoperative goals and milestones, pain score tracking, and connection to clinicians as needed. Patients assigned to receive monitoring were further randomized evenly to remote monitoring alone or remote monitoring with gamification and social support. Remote monitoring was offered before surgery, began at hospital discharge, and continued for 45 days postdischarge. Main Outcomes and Measures The primary outcome was discharge status (home vs skilled nursing facility or inpatient rehabilitation). Prespecified secondary outcomes included change in average daily step count and rehospitalizations. Results A total of 242 patients were analyzed (124 usual care, 118 intervention); median age was 66 years (interquartile range, 58-73 years); 78.1% were women, 45.5% were White, 43.4% were Black; and 81.4% in the intervention arm agreed to receive monitoring. There was no significant difference in the rate of discharge to home between the usual care arm (57.3%; 95% CI, 48.5%-65.9%) and the intervention arm (56.8%; 95% CI, 47.9%-65.7%) and no significant increase in step count in those receiving remote monitoring plus gamification and social support compared with remote monitoring alone. There was a statistically significant reduction in rehospitalization rate in the intervention arm (3.4%; 95% CI, 0.1%-6.7%) compared with the usual care arm (12.2%; 95% CI, 6.4%-18.0%) (P = .01). Conclusions and Relevance In this study, the remote monitoring program did not increase rate of discharge to home after hip or knee arthroplasty, and gamification and social support did not increase activity levels. There was a significant reduction in rehospitalizations among those receiving the intervention, which may have resulted from goal setting and connection to the care team. Trial Registration ClinicalTrials.gov Identifier: NCT03435549.
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Affiliation(s)
- Shivan J. Mehta
- Perelman School of Medicine, Department of Medicine, University of Pennsylvania, Philadelphia
- Center for Health Incentives and Behavioral Economics, University of Pennsylvania, Philadelphia
- Penn Medicine Center for Health Care Innovation, Philadelphia, Pennsylvania
| | - Eric Hume
- Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia
| | - Andrea B. Troxel
- Division of Biostatistics, Department of Population Health, NYU Grossman School of Medicine, New York, New York
| | - Catherine Reitz
- Center for Health Incentives and Behavioral Economics, University of Pennsylvania, Philadelphia
- Penn Medicine Center for Health Care Innovation, Philadelphia, Pennsylvania
| | - Laurie Norton
- Center for Health Incentives and Behavioral Economics, University of Pennsylvania, Philadelphia
| | - Hannah Lacko
- Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia
| | - Caitlin McDonald
- Center for Health Incentives and Behavioral Economics, University of Pennsylvania, Philadelphia
- Penn Medicine Center for Health Care Innovation, Philadelphia, Pennsylvania
| | - Jason Freeman
- Center for Health Incentives and Behavioral Economics, University of Pennsylvania, Philadelphia
| | - Noora Marcus
- Center for Health Incentives and Behavioral Economics, University of Pennsylvania, Philadelphia
| | - Kevin G. Volpp
- Perelman School of Medicine, Department of Medicine, University of Pennsylvania, Philadelphia
- Center for Health Incentives and Behavioral Economics, University of Pennsylvania, Philadelphia
- Penn Medicine Center for Health Care Innovation, Philadelphia, Pennsylvania
- Center for Health Equity Research and Promotion, Philadelphia Veterans Affairs Medical Center, Philadelphia, Pennsylvania
| | - David A. Asch
- Perelman School of Medicine, Department of Medicine, University of Pennsylvania, Philadelphia
- Center for Health Incentives and Behavioral Economics, University of Pennsylvania, Philadelphia
- Penn Medicine Center for Health Care Innovation, Philadelphia, Pennsylvania
- Center for Health Equity Research and Promotion, Philadelphia Veterans Affairs Medical Center, Philadelphia, Pennsylvania
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19
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The Impact of the COVID-19 Pandemic on Genitourinary Cancer Care: Re-envisioning the Future. Eur Urol 2020; 78:731-742. [PMID: 32893062 PMCID: PMC7471715 DOI: 10.1016/j.eururo.2020.08.030] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Accepted: 08/20/2020] [Indexed: 12/14/2022]
Abstract
CONTEXT The coronavirus disease 2019 (COVID-19) pandemic necessitated rapid changes in medical practice. Many of these changes may add value to care, creating opportunities going forward. OBJECTIVE To provide an evidence-informed, expert-derived review of genitourinary cancer care moving forward following the initial COVID-19 pandemic. EVIDENCE ACQUISITION A collaborative narrative review was conducted using literature published through May 2020 (PubMed), which comprised three main topics: reduced in-person interactions arguing for increasing virtual and image-based care, optimisation of the delivery of care, and the effect of COVID-19 in health care facilities on decision-making by patients and their families. EVIDENCE SYNTHESIS Patterns of care will evolve following the COVID-19 pandemic. Telemedicine, virtual care, and telemonitoring will increase and could offer broader access to multidisciplinary expertise without increasing costs. Comprehensive and integrative telehealth solutions will be necessary, and should consider patients' mental health and access differences due to socioeconomic status. Investigations and treatments will need to maximise efficiency and minimise health care interactions. Solutions such as one stop clinics, day case surgery, hypofractionated radiotherapy, and oral or less frequent drug dosing will be preferred. The pandemic necessitated a triage of those patients whose treatment should be expedited, delayed, or avoided, and may persist with severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) in circulation. Patients whose demographic characteristics are at the highest risk of complications from COVID-19 may re-evaluate the benefit of intervention for less aggressive cancers. Clinical research will need to accommodate virtual care and trial participation. Research dissemination and medical education will increasingly utilise virtual platforms, limiting in-person professional engagement; ensure data dissemination; and aim to enhance patient engagement. CONCLUSIONS The COVID-19 pandemic will have lasting effects on the delivery of health care. These changes offer opportunities to improve access, delivery, and the value of care for patients with genitourinary cancers but raise concerns that physicians and health administrators must consider in order to ensure equitable access to care. PATIENT SUMMARY The coronavirus disease 2019 (COVID-19) pandemic has dramatically changed the care provided to many patients with genitourinary cancers. This has necessitated a transition to telemedicine, changes in threshold or delays in many treatments, and an opportunity to reimagine patient care to maintain safety and improve value moving forward.
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20
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Shen TS, Driscoll DA, Islam W, Bovonratwet P, Haas SB, Su EP. Modern Internet Search Analytics and Total Joint Arthroplasty: What Are Patients Asking and Reading Online? J Arthroplasty 2020; 36:1224-1231. [PMID: 33162279 PMCID: PMC7573653 DOI: 10.1016/j.arth.2020.10.024] [Citation(s) in RCA: 47] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Revised: 10/03/2020] [Accepted: 10/14/2020] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Patients considering total joint arthroplasty often search for information online regarding surgery; however, little is known about the specific topics that patients search for and the nature of the information provided. Google compiles frequently asked questions associated with a search term using machine learning and natural language processing. Links to individual websites are provided to answer each question. Analysis of this data may help improve understanding of patient concerns and inform more effective counseling. METHODS Search terms were entered into Google for total hip and total knee arthroplasty. Frequently asked questions and associated websites were extracted to a database using customized software. Questions were categorized by topic; websites were categorized by type. JAMA Benchmark Criteria were used to assess website quality. Pearson's chi-squared and Student's t-tests were performed as appropriate. RESULTS A total of 620 questions (305 total knee arthroplasties, 315 total hip arthroplasties) were extracted with 602 associated websites. The most popular question topics were Specific Activities (23.5%), Indications/Management (15.6%), and Restrictions (13.4%). Questions related to Pain were more common in the TKA group (23.0% vs 2.5%, P < .001) compared to THA. The most common website types were Academic (31.1%), Commercial (29.2%), and Social Media (17.1%). JAMA scores (0-4) were highest for Government websites (mean 3.92, P = .005). CONCLUSION The most frequently asked questions on Google related to total joint arthroplasty are related to arthritis management, rehabilitation, and ability to perform specific tasks. A sizable proportion of health information provided originate from non-academic, non-government sources (64.4%), with 17.1% from social media websites.
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Affiliation(s)
- Tony S. Shen
- Adult Reconstruction and Joint Replacement Service, Hospital for Special Surgery, New York, NY,Department of Orthopaedic Surgery, NewYork-Presbyterian Hospital, Weill Cornell Medical Center, New York, NY,Reprint requests: Tony S. Shen, MD, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021
| | - Daniel A. Driscoll
- Adult Reconstruction and Joint Replacement Service, Hospital for Special Surgery, New York, NY,Department of Orthopaedic Surgery, NewYork-Presbyterian Hospital, Weill Cornell Medical Center, New York, NY
| | - Wasif Islam
- Department of Orthopaedic Surgery, NewYork-Presbyterian Hospital, Weill Cornell Medical Center, New York, NY
| | - Patawut Bovonratwet
- Adult Reconstruction and Joint Replacement Service, Hospital for Special Surgery, New York, NY,Department of Orthopaedic Surgery, NewYork-Presbyterian Hospital, Weill Cornell Medical Center, New York, NY
| | - Steven B. Haas
- Adult Reconstruction and Joint Replacement Service, Hospital for Special Surgery, New York, NY
| | - Edwin P. Su
- Adult Reconstruction and Joint Replacement Service, Hospital for Special Surgery, New York, NY
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21
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Lanssens D, Thijs IM, Gyselaers W. Design of the Pregnancy REmote MOnitoring II study (PREMOM II): a multicenter, randomized controlled trial of remote monitoring for gestational hypertensive disorders. BMC Pregnancy Childbirth 2020; 20:626. [PMID: 33059633 PMCID: PMC7565319 DOI: 10.1186/s12884-020-03291-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Accepted: 09/27/2020] [Indexed: 12/24/2022] Open
Abstract
Background Observational data from the retrospective, non-randomized Pregnancy REmote MOnitoring I (PREMOM I) study showed that remote monitoring (RM) may be beneficial for prenatal observation of women at risk for gestational hypertensive disorders (GHD) in terms of clinical outcomes, health economics, and stakeholder perceptions. PREMOM II is a prospective, randomized, multicenter follow-up study that was performed to explore these promising results. Methods After providing written consent, 3922 pregnant women aged ≥18 years who are at increased risk of developing GHD will be randomized (1:1:1 ratio) to (a) conventional care (control group), (b) a patient self-monitoring group, and (c) a midwife-assisted RM group. The women in each group will be further divided (1:1 ratio) to evaluate the outcomes of targeted or non-targeted (conventional) antihypertensive medication. Women will be recruited in five hospitals in Flanders, Belgium: Ziekenhuis Oost-Limburg, Universitaire Ziekenhuis Antwerpen, Universitaire Ziekenhuis Leuven, AZ Sint Jan Brugge–Oostende, and AZ Sint Lucas Brugge. The primary outcomes are: (1) numbers and types of prenatal visits; (2) maternal outcomes; (3) neonatal outcomes; (4) the applicability and performance of RM; and (5) compliance with RM and self-monitoring. The secondary outcomes are: (1) cost-effectiveness and willingness to pay; (2) patient-reported outcome measures (PROMS) questionnaires on the experiences of the participants; and (3) the maternal and perinatal outcomes according to the type of antihypertensive medication. Demographic, and maternal and neonatal outcomes are collected from the patients’ electronic records. Blood pressure and compliance rate will be obtained from an online digital coordination platform for remote data handling. Information about the healthcare-related costs will be obtained from the National Coordination Committee of Belgian Health Insurance Companies (Intermutualistisch Agentschap). PROMS will be assessed using validated questionnaires. Discussion To our knowledge, this is the first randomized trial comparing midwife-assisted RM and self-monitoring of prenatal blood pressure versus conventional management among women at increased risk of GHD. Positive results of this study may lead to a practical framework for caregivers, hospital management, and payers to introduce RM into the prenatal care programs of high-risk pregnancies. Trial registration This study was registered on clinicaltrials.gov, identification number NCT04031430. Registered 24 July 2019, https://clinicaltrials.gov/ct2/show/NCT04031430?cond=premom+ii&draw=2&rank=1.
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Affiliation(s)
- Dorien Lanssens
- Ziekenhuis Oost-Limburg, Future Health Department, Limburg Clinical Research Center/Mobile Health Unit, Genk, Belgium. .,Department of Obstetrics and Gynaecology, Ziekenhuis Oost-Limburg, Genk, Belgium. .,Faculty of Medicine and Life Sciences, Limburg Clinical Research Center/Mobile Health, UnitUHasselt - ZOL, Hasselt University, Martelarenlaan 42, 3500, Hasselt, Belgium.
| | - Inge M Thijs
- Ziekenhuis Oost-Limburg, Future Health Department, Limburg Clinical Research Center/Mobile Health Unit, Genk, Belgium.,Faculty of Medicine and Life Sciences, Limburg Clinical Research Center/Mobile Health, UnitUHasselt - ZOL, Hasselt University, Martelarenlaan 42, 3500, Hasselt, Belgium
| | - Wilfried Gyselaers
- Department of Obstetrics and Gynaecology, Ziekenhuis Oost-Limburg, Genk, Belgium.,Faculty of Medicine and Life Sciences, Limburg Clinical Research Center/Mobile Health, UnitUHasselt - ZOL, Hasselt University, Martelarenlaan 42, 3500, Hasselt, Belgium
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22
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Patro SP, Padhy N, Chiranjevi D. Ambient assisted living predictive model for cardiovascular disease prediction using supervised learning. EVOLUTIONARY INTELLIGENCE 2020. [DOI: 10.1007/s12065-020-00484-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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23
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Campbell K, Louie P, Levine B, Gililland J. Using Patient Engagement Platforms in the Postoperative Management of Patients. Curr Rev Musculoskelet Med 2020; 13:479-484. [PMID: 32388724 PMCID: PMC7340698 DOI: 10.1007/s12178-020-09638-8] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
PURPOSE OF REVIEW The purpose of this review is to contextualize the topic of patient engagement in orthopedic surgery. There will be a specific focus on patient engagement platforms and the impact on outcomes and orthopedic clinical workflows. RECENT FINDINGS In an attempt to engage patients and optimize the orthopedic perioperative surgical home, patient engagement platforms have emerged in the form of portals, mobile health applications, and chatbots. Collectively, these platforms have improved patient satisfaction scores and outcomes. Patient portals, mobile health applications, and chatbots can engage orthopedic patients and improve the effectiveness of the perioperative orthopedic surgical home. There are specific differences in these applications that should be noted and accounted for. When deciding to incorporate one of these systems into your practice, it is paramount to identify what you are looking to improve upon within your health system and choose a platform accordingly.
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Affiliation(s)
- Kevin Campbell
- Department of Orthopedic Surgery, University of Utah, Salt Lake City, UT USA
| | - Philip Louie
- Department of Orthopedic Surgery, Hospital for Special Surgery, New York, NY USA
| | | | - Jeremy Gililland
- Department of Orthopedic Surgery, University of Utah, Salt Lake City, UT USA
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24
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Behmanesh A, Sadoughi F, Mazhar FN, Joghataei MT, Yazdani S. Tele-orthopaedics: A systematic mapping study. J Telemed Telecare 2020; 28:3-23. [PMID: 32393139 DOI: 10.1177/1357633x20919308] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
INTRODUCTION The use of telemedicine in orthopaedics can provide high-quality orthopaedic services to patients in remote areas. Tele-orthopaedics is widely acknowledged for decreasing travel, time and cost, increasing accessibility and quality of care. In the absence of a comprehensive review on tele-orthopaedics applications and services, here, we systematically identify and classify the tele-orthopaedic applications and services and provide an overview of the trends in the field. METHODS In this study, a systematic mapping was conducted to answer six research questions, we searched the databases Scopus, PubMed, IEEE Digital Library and Web of Science up to 2019. Consequently, 77 papers were screened and selected on the basis of specific inclusion and exclusion criteria. RESULTS We found that mobile-based teleconsultation was mostly asynchronous, while non-mobile teleconsultation was synchronous. The results showed that the physician-patient relationship was more common than other interactions, such as physician-physician and physician-robot interactions. In addition, more than half of the services provided by tele-orthopaedics have been used for orthopaedic diseases/traumas in which joint replacement and fracture reduction have been the most important orthopaedic procedures. It has been noted that more attention has been paid to tele-orthopaedics in developed countries such as the USA, Australia, Canada and Finland. DISCUSSION Telemonitoring (teleconsultation and telemetry) and telesurgery (telerobotics and telementoring) were found to be the two major forms of tele-orthopaedics. Mobile phones were used asynchronously in most of the teleconsultations. The development of different applications may result in the use of multiple smartphones applications in real-time teleconsultation. The use of smartphones is expected to increase in the near future.
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Affiliation(s)
- Ali Behmanesh
- Student Research Committee, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Farahnaz Sadoughi
- Health Management and Economics Research Centre, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Farid Najd Mazhar
- Bone and Joint Reconstruction Research Centre, Shafa Orthopaedic Hospital, Iran University of Medical Sciences, Tehran, Iran
| | | | - Shahram Yazdani
- School of Management and Medical Education Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Van Winkle B, Solad Y, Vaswani N, Rosner BI. Navigating the Digital Health Ecosystem to Bridge the Gap from Innovation to Transformation: A NODE. Health Perspective on Digital Evidence. Digit Biomark 2020; 3:83-91. [PMID: 32095768 DOI: 10.1159/000500194] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2018] [Accepted: 03/25/2019] [Indexed: 11/19/2022] Open
Abstract
This article examines the challenges of broad adoption of digital solutions within the healthcare industry and why evidence is so critical for advancement of digital health technologies. It then illustrates how emerging nonprofits are positioned to help the ecosystem overcome these challenges and to catalyze the process of matching the right evidence-based solution to the right clinical challenge.
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Affiliation(s)
| | - Yauheni Solad
- Digital Health and Telemedicine, Yale New Haven Health, Stratford, Connecticut, USA
| | | | - Benjamin I Rosner
- Division of Hospital Medicine and the Center for Clinical Informatics and Improvement Research, University of California San Francisco, San Francisco, California, USA
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Being a foot and ankle surgeon in Italy in the era of COVID-19. Knee Surg Sports Traumatol Arthrosc 2020; 28:1679-1682. [PMID: 32328698 PMCID: PMC7179794 DOI: 10.1007/s00167-020-06024-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2020] [Accepted: 04/21/2020] [Indexed: 01/19/2023]
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Habibzadeh H, Dinesh K, Shishvan OR, Boggio-Dandry A, Sharma G, Soyata T. A Survey of Healthcare Internet-of-Things (HIoT): A Clinical Perspective. IEEE INTERNET OF THINGS JOURNAL 2020; 7:53-71. [PMID: 33748312 PMCID: PMC7970885 DOI: 10.1109/jiot.2019.2946359] [Citation(s) in RCA: 59] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
In combination with current sociological trends, the maturing development of IoT devices is projected to revolutionize healthcare. A network of body-worn sensors, each with a unique ID, can collect health data that is orders-of-magnitude richer than what is available today from sporadic observations in clinical/hospital environments. When databased, analyzed, and compared against information from other individuals using data analytics, HIoT data enables the personalization and modernization of care with radical improvements in outcomes and reductions in cost. In this paper, we survey existing and emerging technologies that can enable this vision for the future of healthcare, particularly in the clinical practice of healthcare. Three main technology areas underlie the development of this field: (a) sensing, where there is an increased drive for miniaturization and power efficiency; (b) communications, where the enabling factors are ubiquitous connectivity, standardized protocols, and the wide availability of cloud infrastructure, and (c) data analytics and inference, where the availability of large amounts of data and computational resources is revolutionizing algorithms for individualizing inference and actions in health management. Throughout the paper, we use a case study to concretely illustrate the impact of these trends. We conclude our paper with a discussion of the emerging directions, open issues, and challenges.
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Affiliation(s)
- Hadi Habibzadeh
- Department of Electrical and Computer Engineering, SUNY Albany, Albany NY, 12203
| | - Karthik Dinesh
- Department of Electrical and Computer Engineering, University of Rochester, Rochester, NY 14627
| | - Omid Rajabi Shishvan
- Department of Electrical and Computer Engineering, SUNY Albany, Albany NY, 12203
| | - Andrew Boggio-Dandry
- Department of Electrical and Computer Engineering, SUNY Albany, Albany NY, 12203
| | - Gaurav Sharma
- Department of Electrical and Computer Engineering, University of Rochester, Rochester, NY 14627
| | - Tolga Soyata
- Department of Electrical and Computer Engineering, SUNY Albany, Albany NY, 12203
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28
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Quality of Life after Radioembolization for Hepatocellular Carcinoma Using a Digital Patient-Reported Outcome Tool. J Vasc Interv Radiol 2019; 31:311-314.e1. [PMID: 31732223 DOI: 10.1016/j.jvir.2019.06.018] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2019] [Revised: 06/18/2019] [Accepted: 06/23/2019] [Indexed: 11/20/2022] Open
Abstract
Health-related quality of life (HRQoL) measurements are important for patient care, and emerging bundles in value-based care are placing an increasing emphasis on tying reimbursement to patient surveys. A multicenter pilot study was carried out to assess the efficacy of an automated digital patient engagement (DPE) platform for collecting HRQoL measurements at baseline and at 2- to 4-week intervals through 90 days after transarterial radioembolization (TARE) with yttrium-90 (90Y) treatments for hepatocellular carcinoma (HCC). The results revealed a survey completion of 78.4% and demonstrated only 4 of 35 individual symptom instances across all time points of transient worsening relative to baseline. Most importantly, the DPE platform provided an effective means for deploying and collecting patient-reported outcome measures.
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29
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Porten SP, Master VA. Optimizing cystectomy outcomes. Cancer 2019; 125:3502-3503. [PMID: 31299088 DOI: 10.1002/cncr.32359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2019] [Accepted: 05/17/2019] [Indexed: 11/08/2022]
Affiliation(s)
- Sima P Porten
- Department of Urology, University of California San Francisco, San Francisco, California
| | - Viraj A Master
- Department of Urology, Emory University School of Medicine, Atlanta, Georgia
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Abstract
PURPOSE OF REVIEW Telehealth, or the remote delivery of healthcare services using telecommunications technology, has the potential to revolutionize the delivery of healthcare and contribute to ongoing efforts to provide high-value care. RECENT FINDINGS We discuss several categories of telehealth that have been applied to healthcare. Several of these approaches, in particular video visits and teleconsultations, have promising early data demonstrating the significant benefits of telehealth technology with respect to the quality of care, access, cost savings, and patient experience. Nonetheless, considerable knowledge gaps still exist regarding how and for which patients and diseases telehealth modalities should be applied. Finally, we discuss the barriers to widespread adoption at the institutional, state, and federal levels. SUMMARY Maximizing the value of healthcare is an important goal for hospitals, physicians, and policymakers. Telehealth leverages advances in technology and the widespread availability of telecommunications devices to make healthcare communication more available, more convenient, and more efficient for patients and providers. With appropriate policies and incentives, telehealth initiatives can improve the value of urologic care and smooth the transition to a value-based healthcare system.
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Khanwalkar AR, Shen J, Kern RC, Welch KC, Smith SS, Tan BK, Conley DB. Utilization of a novel interactive mobile health platform to evaluate functional outcomes and pain following septoplasty and functional endoscopic sinus surgery. Int Forum Allergy Rhinol 2018; 9:345-351. [DOI: 10.1002/alr.22273] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2018] [Revised: 10/28/2018] [Accepted: 11/18/2018] [Indexed: 01/04/2023]
Affiliation(s)
- Ashoke R. Khanwalkar
- Department of Otolaryngology–Head and Neck SurgeryNorthwestern University Feinberg School of Medicine Chicago IL
| | - Jasper Shen
- Department of Otolaryngology–Head and Neck SurgeryNorthwestern University Feinberg School of Medicine Chicago IL
| | - Robert C. Kern
- Department of Otolaryngology–Head and Neck SurgeryNorthwestern University Feinberg School of Medicine Chicago IL
| | - Kevin C. Welch
- Department of Otolaryngology–Head and Neck SurgeryNorthwestern University Feinberg School of Medicine Chicago IL
| | - Stephanie S. Smith
- Department of Otolaryngology–Head and Neck SurgeryNorthwestern University Feinberg School of Medicine Chicago IL
| | - Bruce K. Tan
- Department of Otolaryngology–Head and Neck SurgeryNorthwestern University Feinberg School of Medicine Chicago IL
| | - David B. Conley
- Department of Otolaryngology–Head and Neck SurgeryNorthwestern University Feinberg School of Medicine Chicago IL
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Lanssens D, Vonck S, Vandenberk T, Schraepen C, Storms V, Thijs IM, Grieten L, Gyselaers W. A Prenatal Remote Monitoring Program in Pregnancies Complicated with Gestational Hypertensive Disorders: What Are the Contributors to the Cost Savings? Telemed J E Health 2018; 25:686-692. [PMID: 30376412 DOI: 10.1089/tmj.2018.0147] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background: In 2015, we performed a cost analysis of a prenatal remote monitoring (RM) program compared with conventional care (CC) for women diagnosed with gestational hypertensive disorders (GHD). Introduction: We investigated where the cost savings were distributed by dividing our patient population into three subgroups, according to the gestational age (GA) at the time of delivery: (1) <34 weeks; (2) 34-37 weeks; and (3) >37 weeks of GA. Materials and Methods: Health care costs were calculated from patient-specific hospital bills at Ziekenhuis Oost Limburg (Genk, Belgium) in 2015-2016. Cost comparisons were made from the perspectives of the Belgium national health care system (HCS), the National Institution for Insurance of Disease and Disability (RIZIV), and the costs to individual patients. Results: A total of 256 pregnant women were included, 80 (31.25%) of whom received RM and 176 (68.75%) of whom received CC. The greatest difference in costs between RM and CC was in the group that delivered before 34 weeks of GA, followed by the group who delivered after 37 weeks of GA, and then the group of women who delivered at 34-37 weeks of GA. Most of the cost savings were in neonatal care, for both the three separate study subgroups and the total study group. Discussion and Conclusion: Our data showed that RM is more cost-effective than CC for pregnant women with GHD. Further investigation of the effects of RM on the long-term economic and social costs is recommended, together with an analysis of the price that should be asked for RM services.
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Affiliation(s)
- Dorien Lanssens
- 1Mobile Health Unit, Faculty of Medicine and Life Sciences, Hasselt University, Hasselt, Belgium.,2Department of Gynaecology, Ziekenhuis Oost-Limburg, Genk, Belgium
| | - Sharona Vonck
- 2Department of Gynaecology, Ziekenhuis Oost-Limburg, Genk, Belgium.,3Department of Health and Life Sciences, Hasselt University, Hasselt, Belgium
| | - Thijs Vandenberk
- 1Mobile Health Unit, Faculty of Medicine and Life Sciences, Hasselt University, Hasselt, Belgium
| | - Cédric Schraepen
- 1Mobile Health Unit, Faculty of Medicine and Life Sciences, Hasselt University, Hasselt, Belgium
| | - Valerie Storms
- 1Mobile Health Unit, Faculty of Medicine and Life Sciences, Hasselt University, Hasselt, Belgium
| | - Inge M Thijs
- 1Mobile Health Unit, Faculty of Medicine and Life Sciences, Hasselt University, Hasselt, Belgium.,4Future Health Department, Ziekenhuis Oost-Limburg, Genk, Belgium
| | - Lars Grieten
- 1Mobile Health Unit, Faculty of Medicine and Life Sciences, Hasselt University, Hasselt, Belgium
| | - Wilfried Gyselaers
- 1Mobile Health Unit, Faculty of Medicine and Life Sciences, Hasselt University, Hasselt, Belgium.,2Department of Gynaecology, Ziekenhuis Oost-Limburg, Genk, Belgium.,5Department of Physiology, Hasselt University, Hasselt, Belgium
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CORR Insights®: Does Orthopaedic Outpatient Care Reduce Emergency Department Utilization After Total Joint Arthroplasty? Clin Orthop Relat Res 2018; 476:1663-1664. [PMID: 29757763 PMCID: PMC6259765 DOI: 10.1097/corr.0000000000000357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
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Rosner BI, Gottlieb M, Anderson WN. Accuracy of Internet-Based Patient Self-Report of Postdischarge Health Care Utilization and Complications Following Orthopedic Procedures: Observational Cohort Study. J Med Internet Res 2018; 20:e10405. [PMID: 30030212 PMCID: PMC6076369 DOI: 10.2196/10405] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2018] [Revised: 04/23/2018] [Accepted: 06/21/2018] [Indexed: 11/30/2022] Open
Abstract
Background The accuracy of patient self-report of health care utilization and complications has yet to be determined. If patients are accurate and engaged self-reporters, collecting this information in a manner that is temporally proximate to the health care utilization events themselves may prove valuable to health care organizations undertaking quality improvement initiatives for which such data are often unavailable. Objective The objective of this study was to measure the accuracy of patient self-report of health care utilization and complications in the 90 days following orthopedic procedures using an automated digital patient engagement platform. Methods We conducted a multicenter real-world observational cohort study across 10 orthopedic practices in California and Nevada. A total of 371 Anthem members with claims data meeting inclusion criteria who had undergone orthopedic procedures between March 1, 2015, and July 1, 2016, at participating practices already routinely using an automated digital patient engagement platform for asynchronous remote guidance and telemonitoring were sent surveys through the platform (in addition to the other materials being provided to them through the platform) regarding 90-day postencounter health care utilization and complications. Their self-reports to structured survey questions of health care utilization and complications were compared to claims data as a reference. Results The mean age of the 371 survey recipients was 56.5 (SD 15.7) years, 48.8% (181/371) of whom were female; 285 individuals who responded to 1 or more survey questions had a mean age of 56.9 (SD 15.4) years and a 49.5% (141/285) female distribution. There were no significant differences in demographics or event prevalence rates between responders and nonresponders. With an overall survey completion rate of 76.8% (285/371), patients were found to have accuracy of self-report characterized by a kappa of 0.80 and agreement of 0.99 and a kappa of 1.00 and agreement of 1.00 for 90-day hospital admissions and pulmonary embolism, respectively. Accuracy of self-report of 90-day emergency room/urgent care visits and of surgical site infection were characterized by a kappa of 0.45 and agreement of 0.96 and a kappa of 0.53 and agreement of 0.97, respectively. Accuracy for other complications such as deep vein thrombosis, hemorrhage, severe constipation, and fracture/dislocation was lower, influenced by low event prevalence rates within our sample. Conclusions In this multicenter observational cohort study using an automated internet-based digital patient engagement platform, we found that patients were most accurate self-reporters of 90-day hospital admissions and pulmonary embolism, followed by 90-day surgical site infection and emergency room/urgent care visits. They were less accurate for deep vein thrombosis and least accurate for hemorrhage, severe constipation, and fracture/dislocation. A total of 76.8% (285/371) of patients completed surveys without the need for clinical staff to collect responses, suggesting the acceptability to patients of internet-based survey dissemination from and collection by clinical teams. While our methods enabled detection of events outside of index institutions, assessment of accuracy of self-report for presence and absence of events and nonresponse bias analysis, low event prevalence rates, particularly for several of the complications, limit the conclusions that may be drawn for some of the findings. Nevertheless, this investigation suggests the potential that engaging patients in self-report through such survey modalities may offer for the timely and accurate measurement of matters germane to health care organizations engaged in quality improvement efforts post discharge.
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Affiliation(s)
- Benjamin I Rosner
- HealthLoop Inc, Mountain View, CA, United States.,Department of Hospital Medicine, Kaiser Permanente, Santa Clara, CA, United States
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