Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada.
Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.
JAMA Surg. 2017 Jul 1;152(7):622-627. doi: 10.1001/jamasurg.2017.0111.
In the age of information and patient-centered care, new methods of delivering postoperative care must be developed and evaluated.
To determine whether follow-up care delivered via a mobile app can be used to avert in-person follow-up care visits compared with conventional, in-person follow-up care in the first 30 days following ambulatory surgery.
DESIGN, SETTING, AND PARTICIPANTS: A randomized clinical trial was conducted from February 1 to August 31, 2015, among ambulatory patients undergoing breast reconstruction at an academic ambulatory care hospital. Patients were randomly assigned to receive follow-up care via a mobile app or at an in-person visit during the first 30 days after the operation. Analysis was intention-to-treat.
The primary end point was the number of in-person follow-up visits during the first 30 days after the operation. Secondary end points were the number of telephone calls and emails to health care professionals, patient-reported convenience and satisfaction scores, and rates of complications.
Of the 65 women in the study (mean [SD] age, 47.7 [13.4] years), 32 (49%) were in the mobile app group, and 33 (51%) were in the in-person follow-up care group. Those in the mobile app group attended a mean of 0.66 in-person visits, vs 1.64 in-person visits in the in-person follow-up care group, for a difference of 0.40 times fewer in-person visits (95% CI, 0.24-0.66; P < .001) and sent more emails to their health care professionals during the first 30 days after the operation (mean, 0.65 vs 0.15; incidence rate ratio, 4.13; 95% CI, 1.55-10.99; P = .005) than did patients in the in-person follow-up care group. This statistically significant difference was maintained at 3 months postoperatively. The mobile app group reported higher convenience scores than the in-person follow-up care group (incidence rate ratio, 1.39; 95% CI, 1.09-1.77; P = .008). There was no difference between groups in the number of telephone communications, satisfaction scores, or complication rates.
Patients undergoing ambulatory breast reconstruction can use follow-up care via a mobile app to avert in-person follow-up visits during the first 30 days after the operation. Mobile app follow-up care affects neither complication rates nor patient-reported satisfaction scores, but it improves patient-reported convenience scores.
clinicaltrials.gov Identifier: NCT02318953.
在信息时代和以患者为中心的医疗照护时代，必须开发和评估新的术后护理方法。
确定在门诊手术后的 30 天内，通过移动应用程序提供的随访护理是否可以替代传统的面对面随访护理，从而避免面对面的随访护理。
设计、地点和参与者：这是一项于 2015 年 2 月 1 日至 8 月 31 日期间在一家学术门诊保健医院进行的门诊患者乳房重建的随机临床试验。患者被随机分配通过移动应用程序或在术后的 30 天内进行面对面随访护理。分析是意向性治疗。
主要终点是术后 30 天内的面对面随访就诊次数。次要结局包括与医疗保健专业人员的电话和电子邮件数量、患者报告的便利性和满意度评分，以及并发症发生率。
在这项研究的 65 名女性中（平均[标准差]年龄，47.7[13.4]岁），32 名（49%）在移动应用程序组，33 名（51%）在面对面随访护理组。移动应用程序组的平均就诊次数为 0.66 次，而面对面随访护理组的就诊次数为 1.64 次，因此面对面就诊次数减少了 0.40 次（95%CI，0.24-0.66；P < .001），并且在术后 30 天内给医疗保健专业人员发送的电子邮件更多（平均，0.65 比 0.15；发病率比，4.13；95%CI，1.55-10.99；P = .005）。这种具有统计学意义的差异在术后 3 个月时仍保持。移动应用程序组的便利性评分高于面对面随访护理组（发病率比，1.39；95%CI，1.09-1.77；P = .008）。两组之间的电话通讯次数、满意度评分或并发症发生率没有差异。
接受门诊乳房重建的患者可以使用移动应用程序进行随访护理，以避免在术后 30 天内进行面对面随访。移动应用程序随访护理既不会影响并发症发生率，也不会影响患者报告的满意度评分，但会提高患者报告的便利性评分。
clinicaltrials.gov 标识符：NCT02318953。
