Remote Monitoring May Reduce Readmissions After Total Joint Arthroplasty, Study Finds
Researchers from the University of Pennsylvania saw a 4-fold decline in the rate of patients who returned to the hospital after discharge from total hip arthroplasty (THA) or total knee arthroplasty (TKA) if the patients were enrolled in a program that used wearable step counters and conversational text messaging to keep tabs on recovery, according to a study published in JAMA Network Open.
“There are great opportunities for health systems and clinicians to improve the quality and value of care for patients getting hip and knee joint replacement surgery, and some of the most important advances are focused on what happens when patients return home,” said the study’s lead author, Shivan Mehta, MD, associate chief innovation officer at Penn Medicine. “Technology, behavioral science insights, and care redesign can help to improve care at home and prevent patients from coming back to the hospital unnecessarily.”
Between February 2018 and mid-April 2019, 242 patients (80 THAs, 162 TKAs) were enrolled in a clinical trial to evaluate HomeConnect+, a hovering program powered by a Penn-developed software platform called Way to Health. HomeConnect+ keeps tabs on patients’ recovery and activity through wearable activity trackers, text messages about postoperative goals and milestones, pain score tracking, and connection with the care team.
The study patients were randomized to either standard care (n=124) or remote monitoring (n=118). The intervention began before surgery and patients were monitored for 45 days postoperatively. The researchers found that just 3% of patients in the HomeConnect+ group needed to return to the hospital after discharge, compared with 12% of patients receiving standard care.
“Hospital readmission is a metric of low-quality care and recovery and high cost for patients and health care providers,” said study co-author Eric Hume, MD, an associate clinical professor of orthopaedic surgery and the director of quality and safety in orthopaedic surgery at Penn Medicine. “Clinicians always respond to poor quality, of course, but accountable care organizations and those working under bundled payment agreements are very interested in value – the ratio of quality over cost. Work like this points to the benefit of technology as a way to support quality care.”
The researchers theorized that “hovering” over patients in an automated way led to a drop in readmissions. With this remote monitoring, clinicians can respond to issues that arise and can take action before there is a larger problem. Absent monitoring, some complications could go undetected until they became a more complex problem.
Although the study showed significant reductions in hospital readmissions, the researchers measured other outcomes as well, including the rate of discharge to home after surgery instead of to a rehabilitation or nursing facility and increased physical activity, which is important for recovery. There was no significant difference in either outcome between groups, even among a subgroup who participated in a “game” designed to nudge participants toward their step goals.
However, the researchers remain optimistic that if the program expands in duration, it could improve activity levels.
“It would be interesting to see what happens to activity levels in the months after the 45 days immediately post-discharge that we studied this time,” Dr. Mehta said.
The researchers are planning to institute some of the findings, such as conversational text messaging, goal setting, and connection to clinicians, for patients at Penn Presbyterian Medical Center in the coming months, with continued monitoring of patient outcomes following implementation.
Mehta SJ, Hume E, Troxel AB, et al. Effect of remote monitoring on discharge to home, return to activity, and rehospitalization after hip and knee arthroplasty: a randomized clinical trial. JAMA Netw Open. 2020;3(12):e2028328. doi:10.1001/jamanetworkopen.2020.28328