Improving outcomes with remote monitoring

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Original content created for Stryker ©2019

 

Hip and knee replacements are among the most frequently performed operating room procedures in the U.S. and the numbers are increasing.According to a 2018 study, total hip arthroplasty (THA) is projected to grow 71% by 2030 and total knee arthroplasty (TKA) is projected to grow 85% by 2030.The same study found that the mean ages for THA and TKA procedures has declined from approximately 66 to 64 years for hips and 68 to 66 years for knees, reflecting a potentially more active and technologically savvy patient population than past patients.2 Concurrently, technology adoption and internet usage among seniors has grown dramatically within the past five years.3 A 2017 Pew survey found that almost half of seniors in the U.S. aged 70 to 74 years own smartphones and 75% use the internet. Among 65 to 69-year-olds, nearly 60% own smartphones and 82% reported using the internet regularly.3

 

Value and Technology in Joint Replacement Surgery

As the number of total joint replacements (TJA) increases—and value-based initiatives continue to dominate the healthcare landscape—numerous opportunities exist for orthopedic surgery to integrate mobile and web-based technologies into patient care in an effort to improve outcomes and potentially reduce unnecessary costs and complications.4

The Centers for Medicare & Medicaid (CMS) has recently introduced certain programs designed with the goal of improving care in knee and hip arthroplasty. A recent payment model, Comprehensive Care for Joint Replacement (CJR), implemented in 2016, focuses on incentivizing quality and cost reductions for Medicare beneficiaries undergoing knee and hip arthroplasties by paying a “target price” for all related care and services within a 90-day episode of care, including post-discharge (subject to certain exclusions).5 Analyses have shown that bundled payments promote multidisciplinary approaches to lower joint replacement care, especially during the post-surgical stage when the risk for costly complications and rehospitalizations is the greatest.5 Multidisciplinary teams that coordinate care and monitor patient recovery have been shown to enhance patient satisfaction, improve efficiencies, and potentially reduce readmissions.5,6,7 While further studies are ongoing, when coupled with smartphones, web-based, and other mobile communications, these technologies have demonstrated the potential to optimize patient outcomes and reduce costs by connecting patients and care teams.6,8

 

The Role of Remote and Electronic Communication in the Care Continuum

Advances in electronic information and communications
technologies have enabled orthopedic surgeons, hospitals, and care teams to share information with knee and hip replacement patients, team members, and other providers across multiple platforms throughout the care continuum.8 Smartphone features such as texting, photographic capabilities, and web-based interfaces have the potential to improve transitions of care from the hospital to the home, enable patients to communicate symptoms both in text and pictures,
respond to automated calls and questionnaires, and encourage patients to be actively engaged in their recovery.8,9 Online patient engagement
portals that can be accessed via smartphone, the internet, or tablets , have also been shown to save costs by replacing in-person follow-up visits (if appropriate), providing discharge instructions to patients and families, and alerting care teams to complications during the recovery period.8,9

Technology also plays a critical role in maximizing patient and care team engagement throughout all stages of the care continuum by preparing patients for surgery, sharing clinical information during the hospital stay, and conveying real-time updates on medication, pain control, and rehabilitation protocols at key points during the recovery period.9,1 Several studies have found that patients undergoing TKA and THA who opt to enroll in web-based preoperative education, as well as participate in technology-enabled programs that promote communication and engagement from the preoperative stage through post-discharge, demonstrated reduced lengths of stays and reported better patient experiences.11,12

 

Remote Monitoring Going Forward

Wearable devices with sensors that monitor activity and provide feedback during the rehabilitation period following TKA and THA are
also under study to determine the feasibility of such devices in promoting exercise adherence, the effect on the relationship between the physical therapist and patient, and the impact on patient outcomes during rehabilitation.13 While more evidence will be required to support
the technology’s efficacy in joint replacement rehabilitation, the potential for integrating wearable sensors into current mobile communications technologies in TJA is promising.13

In recognition of the role technology can play in achieving these goals, CMS recently introduced proposals to pay separately for two new services using communication technology: brief communication technology-based service and remote evaluation of recorded video and/or images submitted by an established patient, allowing practitioners to be reimbursed for mobile patient “check-ins” or for viewing video or other patient images.14

While studies of communications technology in TJA are ongoing, one study demonstrated that patient-engagement and the use of multimedia technology for patients undergoing hip and knee replacement may result in shortened lengths of stay, reduced costs, and an enhanced experience of care.12

 

 

The material is provided for guidance and / or illustrative purposes only and should not be construed as a guarantee of future results or a substitution for legal advice from a healthcare provider. Stryker Performance Solutions does not practice medicine and assumes no responsibility for the administration of patient care.

©2019 Stryker Performance Solutions, LLC

 

 

 


 

References

  1. Most Frequent Operating Room Procedures Performed in US Hospitals. Agency for Healthcare Research and Quality (US); 2014. http://www.ncbi.nlm.nih.gov/pubmed/25695123. Accessed January 25, 2019.
  2. Projected Volume Of Primary Total Joint Arthroplasty In the U.S., 2014 to 2030. A J, Bone Joint Surg Am, Sep 5, 2017. ncbi.nlm.nih.gov/pubmed/30180053 Accessed January 25, 2019.
  3. Tech Adoption Climbs Among Older Adults, Pew Research Center, May 2017, http://www.pewinternet.org/2017/05/17/technology-use among-seniors/ Accessed January 24, 2019. Accessed January 25, 2019
  4. Total knee arthroplasty: improving outcomes with a multidisciplinary approach. J Multidiscip Health Jan, 2018. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5790068/ Accessed January 28, 2019.
  5. Bundled Payments in Total Joint Replacement: Keeping Our Care Affordable and High in Quality. Curr Rev Musculoskelet Med. 2017. https://www.ncbi.nlm.nih.gov/pubmed/28741101 Accessed January 25, 2019.
  6. Technology Assessment and Cost-Effectiveness in Orthopedics: How To Measure Outcomes And Deliver Value in A Constantly Changing Healthcare Environment. Curr Rev Musculoskelet Med. 2017. https://www.ncbi.nlm.nih.gov/pubmed/28421386 Accessed January 28, 2019.
  7. Effects of Clinical Pathways in The Joint Replacement: A Meta-Analysis. BMC Med, July, 2009. https://www.ncbi.nlm.nih.gov/pubmed/19570193 Accessed January 28, 2019.
  8. Mobile Applications for Postoperative Monitoring After Discharge. CMAJ. 2017. https://www.ncbi.nlm.nih.gov/pubmed/27920015. Accessed January 29, 2019.
  9. A Systematic Review of Healthcare Applications for Smartphones. BMC Med Inform Decis Mak. July, 2012. https://www.ncbi.nlm.nih.gov/pubmed/22781312 Accessed January 28, 2019.
  10. Current Use of Telemedicine For Post-Discharge Surgical Care: A Systematic Review. J Am Coll Surg. 2016. https://www.ncbi.nlm.nih.gov/pubmed/27016900 Accessed January 28, 2019.Patient Education Before Hip or Knee Arthroplasty Lowers Length Of Stay. J Arthroplasty, 2010. https://www.ncbi.nlm.nih.gov/pubmed/19427164 Accessed January 29, 2019.
  11. A Patient-Focused Technology-Enabled Program Improves Outcomes in Primary Total Hip And Knee Replacement Surgery. JB JS Open Access, July, 2017. https://journals.lww.com/jbjsoa/FullText/2017/09000/A_Patient_Focused_Technolo y_Enabled_Program.1.aspx Accessed January 29, 2019.
  12. A review of wearable motion tracking systems used in rehabilitation following hip and knee replacement. Journal of Rehabilitation and Assistive Technologies Engineering, March, 2018. https://journals.sagepub.com/doi/full/10.1177/2055668318771816 Accessed January 30, 2019.
  13. Centers for Medicare & Medicaid Services (CMS), Final Policy, Payment, and Quality Provisions Changes to the Medicare Physician Fee Schedule for Calendar Year 2019. https://www.cms.gov/newsroom/fact-sheets/final-policy-payment-and-quality provisions-changes-medicare-physician-fee-schedule-calendar-yearAccessed February 1, 2019.