JMIR Publications

ABSTRACT

Background:

Despite the growth of, and media hype about, digital health technologies, there is a paucity of literature to support the effectiveness of widespread implementation of digital technologies.

Objective:

We sought to assess whether a digital technology system with several overlapping purposes, specifically tele-education and tele-monitoring features, can impact: (a) clinical outcomes (i.e., readmission rates, revisit rates, and length of stay), and (b) patient-centered care outcomes (i.e., patient engagement, patient experience, and patient satisfaction).

Methods:

We compared all patients (2,059 patients) of participating orthopedic surgeons using a digital technology to all patients of non-participating orthopedic surgeons (2,554 patients) practicing at a large academic tertiary medical center. The analyses included Wilcoxon rank-sum tests, Kruskal Wallis tests for continuous variables, and chi-square tests for categorical variables. Logistic regression models were performed on categorical outcomes and a gamma-distributed model of a continuous variable. All the models were adjusted for patient demographics and co-morbidities. Odds ratio (OR) and 95 % confidence intervals [CI] are reported.

Results:

Readmissions: The inpatient readmission rates for the non-participating group when compared to the participating group demonstrated higher odds ratio for 30-day inpatient readmissions (non-participating group=4.02%, participating group=2.64%; OR =1.48 [95% CI, 1.03 – 2.13], p=0.037), 60-day inpatient readmissions (non-participating group=7.36%, participating group = 4.15%; OR =1.79 [95% CI, 1.32 – 2.39], p<0.001), and 90-day inpatient readmissions (non-participating group=9.90%, participating group=5.62%; OR=1.81 [95% CI, 1.40 – 2.34], p<0.001); Length of Stay: The length of stay for the non-participating cohort was 1.90 days, whereas the length of stay for the participating cohort was 1.50 days (1.87 ± 2 vs 1.50 ± 1.37; p <0.001). Patient Engagement: Patients treated by participating surgeons received and read text messages using digital technology 83% of the time and emails 84% of the time. Patients responded to 60% of text messages and 53% of email surveys. Patients were least responsive to digital monitoring questions/prompts when the hospital was asking them to do something, and, they were most engaged with emails that included informational content. Patient Satisfaction: 96% of patients indicated a high satisfaction with using digital technology to support their care. Only seventy-five (0.4%) patients “opted-out” of the digital technology program after enrollment.

Conclusions:

Novel, multi-component, pathway-driven, patient-facing digital technologies can positively impact patient outcomes and patient-reported experiences. These technologies can empower patients to play a more active and meaningful role in improving their outcomes in a way that makes sense to the patients. There is a deep need, however, for a better understanding of the interactions between technology, health care providers, and patients. Future research is needed to (a) help identify, address, and improve technology usability; (b) understand the patient and provider attributes that enable adoption, uptake, and sustainability of technology; and (c) understand factors that contribute to barriers of technology adoption in improving quality health outcomes.