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Bruce CR, Harrison P, Nisar T, Giammattei C, Tan NM, Bliven C, Shallcross J, Khleif A, Tran N, Kelkar S, Tobias N, Chavez AE, Rivera D, Leong A, Romano A, Desai SN, Sol JR, Gutierrez K, Rappel C, Haas E, Zheng F, Park KJ, Jones S, Barach P, Schwartz R. Assessing the Impact of Patient-Facing Mobile Health Technology on Patient Outcomes: Retrospective Observational Cohort Study. JMIR Mhealth Uhealth 2020; 8:e19333. [PMID: 32589161 PMCID: PMC7381069 DOI: 10.2196/19333] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Revised: 05/14/2020] [Accepted: 05/15/2020] [Indexed: 01/04/2023] Open
Abstract
Background Despite the growth of and media hype about mobile health (mHealth), there is a paucity of literature supporting the effectiveness of widespread implementation of mHealth technologies. Objective This study aimed to assess whether an innovative mHealth technology system with several overlapping purposes can impact (1) clinical outcomes (ie, readmission rates, revisit rates, and length of stay) and (2) patient-centered care outcomes (ie, patient engagement, patient experience, and patient satisfaction). Methods We compared all patients (2059 patients) of participating orthopedic surgeons using mHealth technology with all patients of nonparticipating orthopedic surgeons (2554 patients). The analyses included Wilcoxon rank-sum tests, Kruskal-Wallis tests for continuous variables, and chi-square tests for categorical variables. Logistic regression models were performed on categorical outcomes and a gamma-distributed model for continuous variables. All models were adjusted for patient demographics and comorbidities. Results The inpatient readmission rates for the nonparticipating group when compared with the participating group were higher and demonstrated higher odds ratios (ORs) for 30-day inpatient readmissions (nonparticipating group 106/2636, 4.02% and participating group 54/2048, 2.64%; OR 1.48, 95% CI 1.03 to 2.13; P=.04), 60-day inpatient readmissions (nonparticipating group 194/2636, 7.36% and participating group 85/2048, 4.15%; OR 1.79, 95% CI 1.32 to 2.39; P<.001), and 90-day inpatient readmissions (nonparticipating group 261/2636, 9.90% and participating group 115/2048, 5.62%; OR 1.81, 95% CI 1.40 to 2.34; P<.001). The length of stay for the nonparticipating cohort was longer at 1.90 days, whereas the length of stay for the participating cohort was 1.50 days (mean 1.87, SD 2 vs mean 1.50, SD 1.37; P<.001). Patients treated by participating surgeons received and read text messages using mHealth 83% of the time and read emails 84% of the time. Patients responded to 60% of the text messages and 53% of the email surveys. Patients were least responsive to digital monitoring questions when the hospital asked them to do something, and they were most engaged with emails that did not require action, including informational content. A total of 96% (558/580) of patients indicated high satisfaction with using mHealth technology to support their care. Only 0.40% (75/2059) patients opted-out of the mHealth technology program after enrollment. Conclusions A novel, multicomponent, pathway-driven, patient-facing mHealth technology can positively impact patient outcomes and patient-reported experiences. These technologies can empower patients to play a more active and meaningful role in improving their outcomes. There is a deep need, however, for a better understanding of the interactions between patients, technology, and health care providers. Future research is needed to (1) help identify, address, and improve technology usability and effectiveness; (2) understand patient and provider attributes that support adoption, uptake, and sustainability; and (3) understand the factors that contribute to barriers of technology adoption and how best to overcome them.
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Affiliation(s)
- Courtenay R Bruce
- System Quality & Patient Safety, Houston Methodist Hospital System, Houston, TX, United States
| | - Patricia Harrison
- System Quality & Patient Safety, Houston Methodist Hospital System, Houston, TX, United States
| | - Tariq Nisar
- Center for Outcomes Research, Houston Methodist Research Institute, Houston, TX, United States
| | | | - Neema M Tan
- System Quality & Patient Safety, Houston Methodist Hospital System, Houston, TX, United States
| | | | | | - Aroub Khleif
- Information Technology Department, Houston Methodist Hospital, Houston, TX, United States
| | - Nhan Tran
- Information Technology Department, Houston Methodist Hospital, Houston, TX, United States
| | - Sayali Kelkar
- System Quality & Patient Safety, Houston Methodist Hospital System, Houston, TX, United States
| | - Noreen Tobias
- Information Technology Portfolio Management Office, Houston, TX, United States
| | - Ana E Chavez
- Cardiovascular Surgery Associates, Houston Methodist Hospital, Houston, TX, United States
| | - Dana Rivera
- Houston Methodist Orthopedic and Sports Medicine - The Woodlands, Houston Methodist The Woodlands, The Woodlands, TX, United States
| | - Angela Leong
- Clinical Design and Planning, Houston Methodist Hospital System, Houston, TX, United States
| | - Angela Romano
- Houston Methodist Specialty Physician Group, Houston Methodist Orthopedics & Sports Medicine, Houston Methodist Hospital, Houston, TX, United States
| | - S Nicholas Desai
- Department of Orthopedics, Houston Methodist Hospital, Houston, TX, United States
| | - Josh R Sol
- Center for Innovation, Houston Methodist Hospital, Houston, TX, United States
| | - Kayla Gutierrez
- Houston Methodist Specialty Physician Group, Houston Methodist Orthopedics & Sports Medicine, Houston Methodist Hospital, Houston, TX, United States
| | | | - Eric Haas
- Department of Surgery, Houston Methodist Hospital, Houston, TX, United States
| | - Feibi Zheng
- Department of Surgery, Houston Methodist Hospital, Houston, TX, United States
| | - Kwan J Park
- Department of Orthopedics, Houston Methodist Hospital, Houston, TX, United States
| | - Stephen Jones
- Center for Outcomes Research, Houston Methodist Research Institute, Houston, TX, United States
| | - Paul Barach
- Jefferson College of Population Health, Thomas Jefferson University, Philadelphia, PA, United States
| | - Roberta Schwartz
- Center for Innovation, Houston Methodist Hospital, Houston, TX, United States
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