Department of Health and Life Sciences, Northumbria University, Newcastle-upon-Tyne, UK.
Department of Anaesthesia, James Cook University Hospital, Middlesbrough, UK.
BMC Health Serv Res. 2022 Apr 29;22(1):580. doi: 10.1186/s12913-022-07989-1.
As part of an ongoing service improvement project, a digital 'joint school' (DJS) was developed to provide education and support to patients undergoing total hip (THR) and total knee (TKR) replacement surgery. The DJS allowed patients to access personalised care plans and educational resources using web-enabled devices, from being listed for surgery until 12 months post-operation. The aim of this study was to compare a cohort of patients enrolled into the DJS with a cohort of patients from the same NHS trust who received a standard 'non-digital' package of education and support in terms of Health-Related Quality of Life (HRQoL), functional outcomes and hospital length of stay (LoS).
A retrospective comparative cohort study of all patients undergoing primary TKR/THR at a single NHS trust between 1st Jan 2018 and 31st Dec 2019 (n = 2406) was undertaken. The DJS was offered to all patients attending the clinics of early adopting surgeons and the remaining surgeons offered their patient's standard written and verbal information. This allowed comparison between patients that received the DJS (n = 595) and those that received standard care (n = 1811). For each patient, demographic data, LoS and patient reported outcome measures (EQ-5D-3L, Oxford hip/knee scores (OKS/OHS)) were obtained. Polynomial regressions, adjusting for age, sex, Charlson Comorbidity Index (CCI) and pre-operative OKS/OHS or EQ-5D, were used to compare the outcomes for patients receiving DJS and those receiving standard care.
Patients that used the DJS had greater improvements in their EQ-5D, and OKS/OHS compared to patients receiving standard care for both TKR and THR (EQ-5D difference: TKR coefficient estimate (est) = 0.070 (95%CI 0.004 to 0.135); THR est = 0.114 (95%CI 0.061 to 0.166)) and OKS/OHS difference: TKR est = 5.016 (95%CI 2.211 to 7.820); THR est = 4.106 (95%CI 2.257 to 5.955)). The DJS had a statistically significant reduction on LoS for patients who underwent THR but not TKR.
The use of a DJS was associated with improved functional outcomes when compared to a standard 'non-digital' method. The improvements between pre-operative and post-operative outcomes in EQ-5D and OKS/OHS were higher for patients using the DJS. Furthermore, THR patients also had a shorter LoS.
作为一项正在进行的服务改进项目的一部分，开发了一个数字“联合学校”（DJS），为接受全髋关节（THR）和全膝关节（TKR）置换手术的患者提供教育和支持。DJS 允许患者使用支持网络的设备访问个性化的护理计划和教育资源，从接受手术到术后 12 个月。本研究的目的是比较接受 DJS 的患者队列和来自同一 NHS 信托的患者队列，这些患者接受了标准的“非数字”教育和支持包，以评估健康相关生活质量（HRQoL）、功能结果和住院时间（LoS）。
对 2018 年 1 月 1 日至 2019 年 12 月 31 日期间在一家 NHS 信托基金接受初次 TKR/THR 的所有患者进行了回顾性比较队列研究（n=2406）。DJS 提供给所有参加早期采用外科医生诊所的患者，其余外科医生为患者提供标准的书面和口头信息。这允许比较接受 DJS（n=595）和接受标准护理（n=1811）的患者。为每位患者获取人口统计学数据、LoS 和患者报告的结果测量（EQ-5D-3L、牛津髋关节/膝关节评分（OKS/OHS））。使用多项式回归，调整年龄、性别、Charlson 合并症指数（CCI）和术前 OKS/OHS 或 EQ-5D，比较接受 DJS 和接受标准护理的患者的结果。
与接受标准护理的患者相比，使用 DJS 的患者在 THR 和 TKR 方面的 EQ-5D 和 OKS/OHS 都有更大的改善（EQ-5D 差异：TKR 系数估计值（est）=0.070（95%CI 0.004 至 0.135）；THR est=0.114（95%CI 0.061 至 0.166））和 OKS/OHS 差异：TKR est=5.016（95%CI 2.211 至 7.820）；THR est=4.106（95%CI 2.257 至 5.955））。DJS 显著降低了接受 THR 治疗的患者的 LOS，但对接受 TKR 治疗的患者没有影响。
与标准“非数字”方法相比，使用 DJS 与功能结果的改善相关。使用 DJS 的患者在 EQ-5D 和 OKS/OHS 方面的术前和术后结果改善更高。此外，THR 患者的 LOS 也更短。
