Institute of Healthcare Engineering and Management, Department of Industrial Engineering and Management, Aalto University School of Science, Espoo, Finland.
Brain Center, Department of Neurology, Hyvinkää Hospital, Hyvinkää, Finland.
JMIR Hum Factors. 2024 Aug 7;11:e51872. doi: 10.2196/51872.
Helsinki University Hospital has developed a digital care pathway (DCP) for people with multiple sclerosis (MS) to improve the care quality. DCP was designed for especially newly diagnosed patients to support adaptation to a chronic disease.
This study investigated the MS DCP user behavior and its impact on patient education-mediated changes in health care use, patient-perceived impact of MS on psychological and physical functional health, and patient satisfaction.
We collected data from the service launch in March 2020 until the end of 2022 (observation period). The number of users, user logins, and their timing and messages sent were collected. The association of the DCP on health care use was studied in a case-control setting in which patients were allowed to freely select whether they wanted to use the service (DCP group n=63) or not (control group n=112). The number of physical and remote appointments either to a doctor, nurse, or other services were considered in addition to emergency department visits and inpatient days. The follow-up time was 1 year (study period). Furthermore, a subgroup of 36 patients was recruited to fill out surveys on net promoter score (NPS) at 3, 6, and 12 months, and their physical and psychological functional health (Multiple Sclerosis Impact Scale) at 0, 3, 6, and 12 months.
During the observation period, a total of 225 patients had the option to use the service, out of whom 79.1% (178/225) logged into the service. On average, a user of the DCP sent 6.8 messages and logged on 7.4 times, with 72.29% (1182/1635) of logins taking place within 1 year of initiating the service. In case-control cohorts, no statistically significant differences between the groups were found for physical doctors' appointments, remote doctors' contacts, physical nurse appointments, remote nurse contacts, emergency department visits, or inpatient days. However, the MS DCP was associated with a 2.05 (SD 0.48) visit increase in other services, within 1 year from diagnosis. In the prospective DCP-cohort, no clinically significant change was observed in the physical functional health between the 0 and 12-month marks, but psychological functional health was improved between 3 and 6 months. Patient satisfaction improved from the NPS index of 21 (favorable) at the 3-month mark to the NPS index of 63 (excellent) at the 12-month mark.
The MS DCP has been used by a majority of the people with MS as a complementary service to regular operations, and we find high satisfaction with the service. Psychological health was enhanced during the use of MS DCP. Our results indicate that DCPs hold great promise for managing chronic conditions such as MS. Future studies should explore the potential of DCPs in different health care settings and patient subgroups.
赫尔辛基大学医院为多发性硬化症患者开发了一种数字护理路径（DCP），以提高护理质量。DCP 专为新诊断的患者设计，以支持他们适应慢性病。
本研究调查了多发性硬化症 DCP 的用户行为及其对患者教育介导的医疗保健使用变化、患者感知多发性硬化症对心理和身体功能健康的影响，以及患者满意度的影响。
我们收集了 2020 年 3 月服务启动到 2022 年底的数据（观察期）。收集了用户数量、用户登录情况以及登录时间和发送的消息。在病例对照研究中，研究了 DCP 对医疗保健使用的影响，患者可以自由选择是否使用该服务（DCP 组 n=63）或不使用（对照组 n=112）。除了急诊就诊和住院天数外，还考虑了到医生、护士或其他服务的物理和远程预约次数。随访时间为 1 年（研究期）。此外，招募了 36 名患者亚组，在 3、6 和 12 个月时填写净推荐值（NPS）调查，在 0、3、6 和 12 个月时填写他们的身体和心理功能健康（多发性硬化症影响量表）。
在观察期内，共有 225 名患者有使用该服务的选择，其中 79.1%（178/225）登录了该服务。平均而言，DCP 用户发送了 6.8 条消息，登录了 7.4 次，其中 72.29%（1182/1635）的登录发生在服务启动后 1 年内。在病例对照队列中，两组之间在物理医生预约、远程医生联系、物理护士预约、远程护士联系、急诊就诊或住院天数方面均无统计学差异。然而，在诊断后 1 年内，DCP 与其他服务的就诊次数增加了 2.05（SD 0.48）。在前瞻性 DCP 队列中，在 0 到 12 个月的标记之间，身体功能健康没有观察到临床显著变化，但心理功能健康在 3 到 6 个月之间有所改善。患者满意度从 3 个月时的 NPS 指数 21（满意）提高到 12 个月时的 NPS 指数 63（优秀）。
多发性硬化症患者大多将 DCP 用作常规运营的补充服务，我们对该服务的满意度很高。在使用多发性硬化症 DCP 期间，心理健康得到了增强。我们的研究结果表明，DCP 在管理多发性硬化症等慢性病方面具有很大的潜力。未来的研究应探讨 DCP 在不同医疗保健环境和患者亚组中的潜力。
