JMIR Publications

ABSTRACT

Background:

As patients are being discharged from the hospital earlier, the ability to monitor patient recovery between hospital discharge and the first follow-up clinic visit is becoming increasingly important. Despite substantial increases in both internet use and smartphone ownership over the past 5 years, clinicians have been slow to embrace the use of these devices to capture patient recovery information in the period between hospital discharge and the first clinical follow-up appointment.

Objective:

To investigate the generalizability of using a web-based platform to capture patient recovery in a broad surgical patient population, and compare response rates for three different web-based strategies for delivering recovery surveys over the perioperative time-period: email, short message service (SMS) text messaging, and a concurrent mixed approach of using both email and SMS text messaging.

Methods:

Patients undergoing surgeries managed with an Enhanced Recovery After Surgery (ERAS) pathway program were asked to participate in the web-based quality assurance monitoring program at the time of their pre-operative surgery appointment. Different follow-up methods were implemented over three sequential phases. Patients received HIPAA compliant web-based survey links by either email (phase 1), SMS text (phase 2), or concurrently using both email and SMS text (phase 3) using RedCap® and Twillio® software. Recovery assessments using the established Quality of Recovery-9 (QOR-9) tool were measured 4 days prior to surgery, and at 7 and 30 days postoperatively. Generalizability of the web-based system was examined by comparing demographic and clinical characteristics of those who participated vs. those that did not. Differences in response rates by web-based collection method were analyzed in adjusted models.

Results:

A total of 615 patients asked to participate, with 526 (85.53%) opting in to the follow-up program. Those who opted in were younger, slightly healthier, and more likely to be in a partnership. The concurrent mixed modes (CMM) was the most successful method for obtaining responses at every time point compared to text or email alone (pre: 74% vs. 67% vs 43%, P <.001; 7 day: 67% vs. 50% vs. 47%, P = .001; 30 day: 65% vs. 50% vs. 43%, P = .001, respectively). In the adjusted model, the CMM method of contact significantly predicted response compared to using email alone (Odds Ratio (OR) =3.4, P <.0001), and SMS text alone (OR=1.9, P =.0003). Additional significant predictors of response were race, partnership and time.

Conclusions:

For internet users and smartphone owners, electronic capture of recovery surveys appears to be possible through this HIPAA compliant resource friendly mechanism. Discrepancies in both inclusion and response rates still exist among certain subgroups of patients, but the concurrent approach of using both email and text messages was the most effective approach to reach the largest number of patients across all subgroups.