Full text

Turn on search term navigation

© 2021. This work is licensed under https://creativecommons.org/licenses/by/4.0/ (the “License”). Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.

Abstract

Background: Osteoarthritis is a disabling condition that is often associated with other comorbidities. Total hip or knee arthroplasty is an effective surgical treatment for osteoarthritis when indicated, but comorbidities can impair their results by increasing complications and social and economic costs. Integrated care (IC) models supported by eHealth can increase efficiency through defragmentation of care and promote patient-centeredness.

Objective: This study aims to assess the effectiveness and cost-effectiveness of implementing a mobile health (mHealth)–enabled IC model for complex chronic patients undergoing primary total hip or knee arthroplasty.

Methods: As part of the Horizon 2020 Personalized Connected Care for Complex Chronic Patients (CONNECARE) project, a prospective, pragmatic, two-arm, parallel implementation trial was conducted in the rural region of Lleida, Catalonia, Spain. For 3 months, complex chronic patients undergoing total hip or knee arthroplasty and their caregivers received the combined benefits of the CONNECARE organizational IC model and the eHealth platform supporting it, consisting of a patient self-management app, a set of integrated sensors, and a web-based platform connecting professionals from different settings, or usual care (UC). We assessed changes in health status (12-item short-form survey [SF-12]), unplanned visits and admissions during a 6-month follow-up, and the incremental cost-effectiveness ratio.

Results: A total of 29 patients were recruited for the mHealth-enabled IC arm, and 30 patients were recruited for the UC arm. Both groups were statistically comparable for baseline characteristics, such as age; sex; type of arthroplasty; and Charlson index, American Society of Anesthesiologists classification, Barthel index, Hospital Anxiety and Depression scale, Western Ontario and McMaster Universities Osteoarthritis Index, and Pfeiffer mental status questionnaire scores. Patients in both groups had significant increases in the SF-12 physical domain and total SF-12 score, but differences in differences between the groups were not statistically significant. IC patients had 50% fewer unplanned visits (P=.006). Only 1 hospital admission was recorded during the follow-up (UC arm). The IC program generated savings in different cost scenarios, and the incremental cost-effectiveness ratio demonstrated cost-effectiveness.

Conclusions: Chronic patients undergoing hip or knee arthroplasty can benefit from the implementation of patient-centered mHealth-enabled IC models aimed at empowering patients and facilitating transitions from specialized hospital care to primary care. Such models can reduce unplanned contacts with the health system and reduce overall health costs, proving to be cost-effective. Overall, our findings support the notion of system-wide cross-organizational care pathways supported by mHealth as a successful way to implement IC for patients undergoing elective surgery.

Details

Title
Implementing mHealth-Enabled Integrated Care for Complex Chronic Patients With Osteoarthritis Undergoing Primary Hip or Knee Arthroplasty: Prospective, Two-Arm, Parallel Trial
Author
Colomina, Jordi  VIAFID ORCID Logo  ; Reis Drudis  VIAFID ORCID Logo  ; Torra, Montserrat  VIAFID ORCID Logo  ; Pallisó, Francesc  VIAFID ORCID Logo  ; Massip, Mireia  VIAFID ORCID Logo  ; Vargiu, Eloisa  VIAFID ORCID Logo  ; Nadal, Nuria  VIAFID ORCID Logo  ; Fuentes, Araceli  VIAFID ORCID Logo  ; Marta Ortega Bravo  VIAFID ORCID Logo  ; Miralles, Felip  VIAFID ORCID Logo  ; Barbé, Ferran  VIAFID ORCID Logo  ; Torres, Gerard  VIAFID ORCID Logo  ; de Batlle, Jordi  VIAFID ORCID Logo  ; The CONNECARE-Lleida Group 11
First page
e28320
Section
Mobile Health (mhealth)
Publication year
2021
Publication date
Sep 2021
Publisher
Gunther Eysenbach MD MPH, Associate Professor
e-ISSN
1438-8871
Source type
Scholarly Journal
Language of publication
English
ProQuest document ID
2577930955
Copyright
© 2021. This work is licensed under https://creativecommons.org/licenses/by/4.0/ (the “License”). Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.