Milliren Carly E, Lindsay Bill, Biernat Lisa, Smith Todd A, Weaver Betsy
Institutional Centers for Clinical and Translational Research, Boston Children's Hospital, Boston, MA, USA.
UbiCare, Boston, MA, USA.
Digit Health. 2022 Apr 24;8:20552076221095322. doi: 10.1177/20552076221095322. eCollection 2022 Jan-Dec.
Patient activation and engagement can improve outcomes of medical and surgical care by increasing involvement of patients in their care plan. We designed a digital engagement tool to improve surgical cancellation and post-surgical outcomes for adult patients undergoing total joint replacements by providing patient education materials via email or text, in small increments throughout the perioperative period.
We assessed the tool's impact using a quasi-experimental design comparing patients scheduled for surgery January-June 2017 (pre-intervention) versus January-June 2018 (post-intervention). Post-intervention patients with digital contact information in the medical record were automatically enrolled. We extracted de-identified administrative data for all patients during both time periods and utilized an intent-to-treat approach including all post-intervention patients regardless of enrollment. Surgical cancellation and post-surgical outcomes (length of stay, discharge to home and revisits and readmissions) were compared between periods using adjusted regression models. We also examined associations between measures of engagement with the intervention and outcomes.
A total of 2027 joint replacement patients were included (720 hip replacements; 1307 knee replacements). Adjusting for gender, age and insurance type, both hip and knee patients in the post-intervention group were more likely to have a cancelled surgery, but cancellations were less likely to be on the day of surgery compared to pre-intervention patients. Post-intervention patients were also less likely to have length of stay >2 days. Forty- three per cent of hip and 47% of knee patients in the post-period received the intervention and most were highly engaged. Higher engagement was associated with lower odds of surgical cancellation, shorter stays and higher odds of discharge home.
Findings suggest that utilization of a digital patient engagement tool translates into improved hospital efficiency and patient outcomes, particularly for those highly engaged.
患者的激活与参与能够通过增加患者对其护理计划的参与度来改善内科和外科护理的结果。我们设计了一种数字参与工具，通过在围手术期以小增量的方式通过电子邮件或短信提供患者教育材料，来改善接受全关节置换术的成年患者的手术取消率和术后结果。
我们采用准实验设计评估该工具的影响，比较2017年1月至6月安排手术的患者（干预前）与2018年1月至6月安排手术的患者（干预后）。医疗记录中有数字联系信息的干预后患者自动入组。我们提取了两个时间段内所有患者的去标识化管理数据，并采用意向性分析方法，纳入所有干预后患者，无论其是否入组。使用调整后的回归模型比较不同时间段的手术取消率和术后结果（住院时间、出院回家以及复诊和再入院情况）。我们还研究了与干预措施的参与度指标和结果之间的关联。
总共纳入了2027例关节置换患者（720例髋关节置换；1307例膝关节置换）。在调整了性别、年龄和保险类型后，干预后组的髋关节和膝关节患者手术取消的可能性更高，但与干预前患者相比，手术取消不太可能发生在手术当天。干预后患者住院时间>2天的可能性也较小。干预后时期，43%的髋关节患者和47%的膝关节患者接受了干预，且大多数参与度很高。更高的参与度与手术取消几率降低、住院时间缩短以及出院回家几率增加相关。
研究结果表明，使用数字患者参与工具可提高医院效率和患者结果，特别是对于那些参与度高的患者。
