JMIR Publications

ABSTRACT

Background:

Osteoarthritis is a disabling condition often associated with other comorbidities. Total hip or knee arthroplasty are effective surgical treatments for osteoarthritis when indicated but comorbidities can impair their results increasing complications, social and economic costs. Integrated care (IC) models supported by eHealth can generate efficiencies through defragmentation of care and promotion of patient-centeredness.

Objective:

To assess the effectiveness and cost-effectiveness of the implementation of a mHealth-enabled IC model for complex chronic patients undergoing primary total hip or knee arthroplasty.

Methods:

As part of the Horizon 2020 CONNECARE project, a prospective, pragmatic, two-arm, parallel, implementation trial was held in the rural region of Lleida, Catalonia, Spain. For 3 months, chronic complex patients undergoing total hip or knee arthroplasty and their carers experienced the combined benefits of the CONNECARE organizational IC model and the eHealth platform supporting it, consisting on a patients’ self-management app, a set of integrated sensors, and a web-based platform connecting professionals from different settings, or usual care. We assessed changes in health status (SF-12); unplanned visits and admissions during a 6-month follow-up; and, the incremental cost-effectiveness ratio (ICER).

Results:

29 patients were recruited for the mHealth-enabled IC arm (IC) and 30 for the usual care arm (UC). Both groups were statistically comparable for baseline characteristics such age, sex, type of arthroplasty, and Charlson, ASA, Barthel, HAD, WOMAC and Pfeiffer scores. Patients in both groups had significant increases in SF-12 Physical domain and total SF-12 score, but the differences in differences between groups were not statistically significant. IC patients had 50% less unplanned visits (P=0.006). Only one hospital admission was recorded during the follow-up (UC arm). The IC program generated savings in different costs’ scenarios and ICER demonstrated cost-effectiveness.

Conclusions:

Chronic patients undergoing hip or knee arthroplasty can benefit from the implementation of patient-centered mHealth-enabled IC models aiming to empower patients and facilitate transitions from specialized hospital care towards 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.