Remote monitoring program may reduce rehospitalization rate after TJA
Although the rate of discharge after total hip and knee arthroplasty did not increase with use of a remote monitoring program, published results showed remote monitoring led to high patient engagement and a reduced rehospitalization rate.
Shivan J. Mehta, MD, MBA, MSHP, and colleagues randomly assigned 242 patients undergoing hip or knee arthroplasty with a risk assessment and prediction tool score of 6 to 8 to receive either usual care (n=124) or remote monitoring (n=118). Among patients in the remote monitoring group, 81.4% agreed to use a wearable activity monitor to track step count, messaging about postoperative goals and milestones, pain score tracking and connection to clinicians as needed. Researchers also randomly assigned patients in the remote monitoring group to remote monitoring alone or remote monitoring with gamification and social support. Researchers identified discharge status as the primary outcome measure, while change in average daily step count and rehospitalizations were prespecified secondary outcomes.
Results showed the usual care group and the remote monitoring group had no significant differences in the rate of discharge to home. Among patients who received remote monitoring plus gamification and social support, researchers found no significant increase in step count compared with patients who received remote monitoring alone. Patients in the remote monitoring group had a statistically significantly reduced rehospitalization rate of 3.4% vs. 12.2% among patients in the usual care group.
“Hip and knee replacement surgery is common, with a great deal of variation in cost and quality. Most hospitals participate in bundled payments, which hold them accountable for cost of care for an episode,” Mehta told Healio Orthopedics. “In this randomized controlled trial, we found that this remote monitoring program substantially reduced rehospitalizations. In one of the largest studies with activity monitoring post hip and knee replacement, we found that step counts are modest in the first 6 weeks after surgery. Relatively low-cost technology, when designed into clinical workflows, [has] the opportunity to improve value of care.”