Accepted for/Published in: JMIR Perioperative Medicine
Date Submitted: Jun 13, 2020
Date Accepted: Aug 30, 2020
Warning: This is an author submission that is not peer-reviewed or edited. Preprints - unless they show as "accepted" - should not be relied on to guide clinical practice or health-related behavior and should not be reported in news media as established information.
A Smartphone Application with Digital Care Pathway for Patients Undergoing Spine Surgery: Development and Feasibility.
ABSTRACT
Background:
There is great unmet clinical need to provide patients undergoing spinal surgery, and their caregivers, with ongoing, high-quality care before and after surgery in an efficiency-focused healthcare environment.
Objective:
The objective of this study was to design, develop, and evaluate the acceptability and feasibility of a novel, mobile planning, outcomes and analytics-based smartphone application called ManageMySurgery (MMS) in patients undergoing elective spine surgery (MMS-Spine).
Methods:
The development process of the MMS app was conducted over two sequential stages: (1) evidence-based intervention design with refinement from surgeon and patient feedback, and (2) feasibility testing in clinical pilot study. We developed a novel, mobile-based, HIPAA-compliant platform for interventional and surgical procedures. It is a patient-centric mobile health app that streamlines patients’ interactions with their care team. MMS divides the patient journey into phases, making it feasible to provide customized care pathways that meet patients’ unique needs. Patient-Reported Outcomes (PROs) are easily collected and conform to the NIH Patient-Reported Outcomes Measurement Information System (PROMIS®) standard.
Results:
We tested the feasibility of the MMS-Spine application with patients undergoing elective spine surgery at a large academic health system. A total of 47 patients undergoing elective spine surgery (26 cervical spine and 21 lumbar spine) downloaded and utilized MMS-Spine to navigate their surgical journey, quantify their baseline characteristics and post-operative outcomes, and provide feedback on the utility of the application in preparing for and recovering from their spinal surgery. The mean age was 59.0 years (range 33–77), 22 (46.8%) were female, and 26 (55.3%) had commercial insurance. A total of 33 patients (70.2%) logged in on an iOS device, 11 (23.4%) on an Android device and 3 (6.4%) on a computer/tablet. A total of 17 patients (36.2%) added a caregiver, of which 7 (41.2%) logged in. The mean number of sign-ins was 3.2. A total of 38 patients (80.9%) completed their baseline preoperative PROMIS-29 outcomes and 14 patients (29.8%) completed at least 1 PROMIS-29 survey during the postoperative period. Of the 24 patients who completed the MMS survey, 87.5% said it was helpful during preparation for their procedure, 66.7% said it was helpful during the postoperative period and 95.8% said that they would recommend MMS to a friend or family member.
Conclusions:
We used a patient-centered approach, based on proven behavioral change techniques, to develop a comprehensive smartphone application for patients undergoing elective spine surgery. The optimized version of the application is ready for formal testing in a larger randomized clinical study to establish its effect on patients’ self-management skills, long-term outcomes, and cost-effectiveness.
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