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Randomized Controlled Trial
. 2020 Dec 1;3(12):e2028328.
doi: 10.1001/jamanetworkopen.2020.28328.

Effect of Remote Monitoring on Discharge to Home, Return to Activity, and Rehospitalization After Hip and Knee Arthroplasty: A Randomized Clinical Trial

Shivan J Mehta  1   2   3 , Eric Hume  4 , Andrea B Troxel  5 , Catherine Reitz  2   3 , Laurie Norton  2 , Hannah Lacko  4 , Caitlin McDonald  2   3 , Jason Freeman  2 , Noora Marcus  2 , Kevin G Volpp  1   2   3   6 , David A Asch  1   2   3   6
Affiliations
Randomized Controlled Trial

Effect of Remote Monitoring on Discharge to Home, Return to Activity, and Rehospitalization After Hip and Knee Arthroplasty: A Randomized Clinical Trial

Shivan J Mehta et al. JAMA Netw Open. .

Erratum in

  • Errors in SDs in Results and Table 4.
    [No authors listed] [No authors listed] JAMA Netw Open. 2024 Apr 1;7(4):e2412345. doi: 10.1001/jamanetworkopen.2024.12345. JAMA Netw Open. 2024. PMID: 38630481 Free PMC article. No abstract available.

Abstract

Importance: Hip and knee arthroplasty are the most common inpatient surgical procedures for Medicare beneficiaries in the US, with substantial variation in cost and quality. Whether remote monitoring incorporating insights from behavioral science might help improve outcomes and increase value of care remains unknown.

Objective: To evaluate the effect of activity monitoring and bidirectional text messaging on the rate of discharge to home and clinical outcomes in patients receiving hip or knee arthroplasty.

Design, setting, and participants: Randomized clinical trial conducted between February 7, 2018, and April 15, 2019. The setting was 2 urban hospitals at an academic health system. Participants were patients aged 18 to 85 years scheduled to undergo hip or knee arthroplasty with a Risk Assessment and Prediction Tool score of 6 to 8.

Interventions: Eligible patients were randomized evenly to receive usual care (n = 153) or remote monitoring (n = 147). Those in the intervention arm who agreed received a wearable activity monitor to track step count, messaging about postoperative goals and milestones, pain score tracking, and connection to clinicians as needed. Patients assigned to receive monitoring were further randomized evenly to remote monitoring alone or remote monitoring with gamification and social support. Remote monitoring was offered before surgery, began at hospital discharge, and continued for 45 days postdischarge.

Main outcomes and measures: The primary outcome was discharge status (home vs skilled nursing facility or inpatient rehabilitation). Prespecified secondary outcomes included change in average daily step count and rehospitalizations.

Results: A total of 242 patients were analyzed (124 usual care, 118 intervention); median age was 66 years (interquartile range, 58-73 years); 78.1% were women, 45.5% were White, 43.4% were Black; and 81.4% in the intervention arm agreed to receive monitoring. There was no significant difference in the rate of discharge to home between the usual care arm (57.3%; 95% CI, 48.5%-65.9%) and the intervention arm (56.8%; 95% CI, 47.9%-65.7%) and no significant increase in step count in those receiving remote monitoring plus gamification and social support compared with remote monitoring alone. There was a statistically significant reduction in rehospitalization rate in the intervention arm (3.4%; 95% CI, 0.1%-6.7%) compared with the usual care arm (12.2%; 95% CI, 6.4%-18.0%) (P = .01).

Conclusions and relevance: In this study, the remote monitoring program did not increase rate of discharge to home after hip or knee arthroplasty, and gamification and social support did not increase activity levels. There was a significant reduction in rehospitalizations among those receiving the intervention, which may have resulted from goal setting and connection to the care team.

Trial registration: ClinicalTrials.gov Identifier: NCT03435549.

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Conflict of interest statement

Conflict of Interest Disclosures: Dr Mehta reported grants from National Cancer Institute outside the submitted work. Dr Volpp reports personal fees and being a part owner of VAL Health, grants from Hawaii Medical Services Association, grants from Vitality/Discovery, grants from Humana, grants from WW International, personal fees from Center for Corporate Innovation, personal fees from Lehigh Valley Medical Center, personal fees from Vizient, personal fees from Greater Philadelphia Business Coalition on Health, personal fees from American Gastroenterological Association Tech Conference, personal fees from Bridge to Population Health Meeting, and personal fees from Irish Medtech Summit outside the submitted work. None of these are directly related to this work. Dr Asch reported personal fees and other from VAL Health, nonfinancial support from TED MED, personal fees and nonfinancial support from Healthcare Financial Management Association, personal fees from National Alliance of Health Care Purchasing Coalitions, personal fees and nonfinancial support from Alliance for Continuing Education in the Health Professions, personal fees and nonfinancial support from Deloitte, personal fees and nonfinancial support from American Association for Physician Leadership, and personal fees and nonfinancial support from NACCME, LLC outside the submitted work. No other disclosures were reported.

Figures

Figure.
Figure.. CONSORT Flow Diagram
RAPT indicates Risk Assessment and Prediction Tool.
See this image and copyright information in PMC

References

    1. Cram P, Lu X, Kates SL, Singh JA, Li Y, Wolf BR. Total knee arthroplasty volume, utilization, and outcomes among Medicare beneficiaries, 1991-2010. JAMA. 2012;308(12):1227-1236. doi:10.1001/2012.jama.11153 - DOI - PMC - PubMed
    1. Miller DC, Gust C, Dimick JB, Birkmeyer N, Skinner J, Birkmeyer JD. Large variations in Medicare payments for surgery highlight savings potential from bundled payment programs. Health Aff (Millwood). 2011;30(11):2107-2115. doi:10.1377/hlthaff.2011.0783 - DOI - PMC - PubMed
    1. Cutler DM, Ghosh K. The potential for cost savings through bundled episode payments. N Engl J Med. 2012;366(12):1075-1077. doi:10.1056/NEJMp1113361 - DOI - PMC - PubMed
    1. Finkelstein A, Ji Y, Mahoney N, Skinner J. Mandatory Medicare bundled payment program for lower extremity joint replacement and discharge to institutional postacute care: interim analysis of the first year of a 5-year randomized trial. JAMA. 2018;320(9):892-900. doi:10.1001/jama.2018.12346 - DOI - PMC - PubMed
    1. Dummit LA, Kahvecioglu D, Marrufo G, et al. . Association between hospital participation in a Medicare bundled payment initiative and payments and quality outcomes for lower extremity joint replacement episodes. JAMA. 2016;316(12):1267-1278. doi:10.1001/jama.2016.12717 - DOI - PubMed

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