Managed Care System Research Articles

'It enables the carers to see the person first': Qualitative evaluation of point-of-care digital management system in residential aged care.

To evaluate acceptability, efficiency, and quality of a new digital care management system in a residential aged care home (RACH). Improving care quality and efficiency in RACH, while simultaneously upgrading data management, is a priority for communities and governments. Participatory action research with mixed methods data collection was employed to evaluate a digital care management system implemented at a 169-bed RACH. This paper reports qualitative findings of the 2-year evaluation. Qualitative data were collected using focus groups with residents, visitors, nurses, managers, care workers, and consultants; resident/visitor and staff hallway interviews and responses to open-ended questions in online staff surveys. Data were analysed thematically under the four predetermined study objectives. Reporting adhered to COREQ guidelines. 325 data captures from 88 participants, over seven data sources were coded. Findings indicate that the system was acceptable to both residents and staff due to perceptions of time-saving and improved quality of care. Increased efficiency was perceived through timeliness as well as reduced time spent retrieving and documenting information. Quality of care was improved through care scheduling individualised to resident needs, with reminders to avoid missed care. Relatives were reassured and activities were scheduled to loved one's preferences. The co-design implementation process was successful through commitment to quality from leadership teams and prioritising the focus on the holistic needs of the residents. A strong emphasis on co-design with care staff in developing and implementing the digital care system contributed to a system that supported nursing and care work, facilitated reporting and documentation, and improved resident care and well-being including identification of missed care. Nurses, carers, administrators, and advocates can support the co-design creation of information systems that suit the workflow of an organisation and keep the focus on individualised models of care provision.

Population DNA screening for medically actionable disease risk in adults

Population DNA screening for medically actionable disease risk in adults

Enhancing the Quality of Follow-Up Care for Patients With Hepatitis B and C Using an Electronic Reminder System: A 2016-2019 Hospital-Based Study

<p>B、C型肝炎病人需要定期追蹤及檢驗疾病發展狀況，以及早發現肝癌。彰化基督教醫院胃腸肝膽科於2010年開始實行衛生福利部中央健康保險署（下稱健保署）追蹤照護計畫，過程中因病人病識感低，以及門診收案及追蹤流程複雜，截至2016年收案率14.6%、年度完整追蹤率28.8%，皆未達健保署設定的3項品質獎勵監測指標。透過E化之B、C肝照護管理系統，改善並簡化門診收案流程，提升個案管理師收案追蹤效率及提高病人遵從醫囑率，大幅提升了B、C肝病人照護品質。於2017年開始執行E化追蹤管理，2019年收案率提升至58.91%(4542/7710)，年度完整追蹤率達74.45%(3107/4173)。健保署評比2018年度品質獎勵榮獲中區第一名，本院是中區唯一獲得品質獎勵之醫學中心。</p> <p> </p><p>Patients with hepatitis B and C require regular follow-up to monitor disease activity and screen for the presence of hepatocellular carcinoma. Since 2010, Changhua Christian Hospital has implemented a hepatitis B and C care plan guided by the National Health Insurance Administration (NHIA), Ministry of Health and Welfare (MOHW). The rates of patient enrollment and follow-up between 2010 and 2016 were unsatisfactory. The annual enrollment and follow-up rates were only 14.6% and 28.8%, respectively, in 2016, falling below the three quality indicator standards established by the NHIA. The absence of insight into patient disease and the complexity of patient enrollment and follow-up procedures were identified as the main problems. Therefore, in 2017, we developed a strategy for improving and simplifying the patient enrollment process, enhancing the efficiency of the case managers involved in patient enrollment and follow-up, and increasing the rate of medical compliance. An electronic follow-up reminder system was implemented to enhance our quality of care among patients with hepatitis B and C. Thus, in 2019, the annual enrollment and follow-up rates had dramatically increased to 58.91% (4542/7710) and 74.45% (3107/4173), respectively. Because of the improved care management system, our hospital was the only medical center in central Taiwan that won an NHI Quality Award in 2018.</p> <p> </p>

Understanding the association between frequent emergency department use and jail incarceration: A cross-sectional analysis.

Frequent emergency department (ED) use and incarceration can be driven by underlying structural factors and social needs. If frequent ED users are at increased risk for incarceration, ED-based interventions could be developed to mitigate this risk. The objective of this study was to determine whether frequent ED use is associated with incarceration. We conducted a retrospective cross-sectional study of 46,752 individuals in San Francisco Department of Public Health's interagency, integrated Coordinated Care Management System (CCMS) during fiscal year 2018-2019. The primary exposure was frequency of ED visits, and the primary outcome was presence of any county jail incarceration during the study period. We performed descriptive and multivariable analysis to determine the association between the frequency of ED use and jail encounters. The percentage of those with at least one episode of incarceration during the study period increased with increasing ED visit frequency. Unadjusted odds of incarceration increased with ED use frequency: odds ratio (OR)=2.14 (95% confidence interval [CI]=1.94-2.35) for infrequent use, OR=4.98 (95% CI= 4.43-5.60) for those with frequent ED use, and OR= 12.33 (95% CI=9.59-15.86) for those with super-frequent ED use. After adjustment for observable confounders, the odds of incarceration for those with super-frequent ED use remained elevated at 2.57 (95% CI=1.94-3.41). Of those with super-frequent ED use and at least one jail encounter, 18% were seen in an ED within 30 days after release from jail and 25% were seen in an ED within 30 days prior to arrest. Frequent ED use is independently associated with incarceration. The ED may be a site for intervention to prevent incarceration among frequent ED users by addressing unmet social needs.

Construction and practice of practical teaching system for intelligent health care service and management in vocational colleges

In the context of an aging population, the shortage of senior care practitioners and the lack of professional capabilities have become increasingly prominent. In order to adapt to the new situation of the development of senior care services, new standards and new requirements have been put forward for the practical teaching of smart and healthy senior care services and management. Through the construction and practice of the practical teaching system of smart and healthy elderly care services and management, the basic framework of the practical teaching system, the curriculum system, the platform construction and evaluation mechanism, and the construction effect are discussed, forming a "four-in-one" practice. The teaching system lays the foundation for deepening the practical teaching reform of smart and healthy elderly care services and management, and cultivating high-quality technical and skilled talents.

Número de equipes assistenciais e internações por condições sensíveis à atenção primária

Abstract This study aimed to analyze the correlation between the number of health care teams of the Family Health Strategy (FHS) and the number of hospitalizations due to primary care sensitive conditions (HPCSC) taking into account rates, costs and hospital days in a large municipality of the state of Minas Gerais, Brazil, between 2010 and 2019. We performed an ecological time series correlation study on HPCSC of patients hospitalized by the public health system. Data were obtained from the Hospital Information System of the IT Department of the Public Health System (DATASUS) and from the Primary Care Information and Management System. The correlation analysis was performed based on the number, gross and standardized rates, percentages, costs and hospital days of HPCSC and health care coverage (average number of teams) using Spearman’s correlation coefficient at a significance level of 5% (p < 0.05). No satisfactory correlation was found in the entire period between the increase in the number of health care teams and HPCSC (except for the standardized hospitalization rate). However, during the period in which the FHS coverage of the population was greater than 70%, all correlations were inversely proportional and statistically significant.

A Strategic approach of Health care management system & proactive safety measures to achieve Zero Accident and Zero Incident from Apr 2020 to March 2021 at Large Petrochemical Manufacturing Division

A Strategic approach of Health care management system & proactive safety measures to achieve Zero Accident and Zero Incident from Apr 2020 to March 2021 at Large Petrochemical Manufacturing Division

Mogućnost unapređenja menadžmenta stomatološke zdravstvene zaštite - studija slučaja ordinacije "Vukadinović" u Republici Srbiji

Introduction: Dental medicine is a part of health care which is responsible for providing dental health care for the population of an area using all available means - by preserving, improving and establishing the specific functions and the appearance of the oral cavity and its individual parts, by studying and preventing common diseases of the mouth, as well as by treating diseases, disorders and mouth and dental injuries. The system of dental health care in the Republic of Serbia requires changes in the field of legislation and the organizational process, as well as financial investments for the purpose of improving the organizational process and achieving a greater number of professional staff that would provide dental services. The McKinsey 7S Model is a good tool for checking the managing abilities and the capacity of a certain organization to respond to the modern demands of its users. Aim: The aim of the paper was to investigate the prospects of improving the current dental health care management system. Methods: The method involves a case study on applying the McKinsey 7S diagnostic model to a private dental practice. Results: The results of the research served as the basis for proposing potential improvements to dental health care management.

Front-End Design of Pet Care Management System

Considering that more and more people in the family are starting to keep pets and they are treating pets as part of the family, they are increasingly concerned about the life and health of pets, so our group has developed a set of pet care appointments and pet products to purchase. A pet care management system. This system can help pet owners to take care of their pet baby more conveniently. This project is a back-end management project based on the B/S model. The project adopts the MVC design pattern. The front end uses the Bootstrap framework, the database uses the MySQL database, and SVN is used as the project management tool. After the project is completed, an environment is set up on the cloud server, and a war package is installed on the server. At the same time, the initial application of the project on the Android terminal is completed. This article introduces the MySQL database, ajax, json, and MVC patterns used in the front-end development process.

Социолого-статистический мониторинг в информационном обеспечении управления здравоохранением региона

The use of sociological and statistical monitoring as an effective research strategy is of high significance in the management of health care and in the development of managerial decisions aimed at addressing the region’s health care issues. The adaptability of sociological and statistical monitoring is directly connected with resolving the research tasks applied in the documents of strategic planning in the public health sphere. The study reveals the reasons hindering the development of the health care system in the Bryansk region, among which are the presence of settlements without medical infrastructure and staff turnover. These issues force patients to use medical institutions in other regions and financial withdrawal from the region. The author recommends analyzing the effectiveness of health care system management in the Bryansk region regarding the essence of regional programs and projects and the presence of motivational factors elected by respondents when answering the questionnaires. Medical workers can either support or reject decisions made by the administration, which, in turn, directly affects the number of medical personnel in the Bryansk region. Sociological and statistical data received in the monitoring program can become the basis for developing a universal model of the health care system, considering the regional characteristics.

Access to rehabilitation services for road traffic injury patients in Namibia

Purpose Road traffic injuries (RTIs) are a major public health issue worldwide. The importance of physical rehabilitation following RTI is well documented. However, globally there has been very little research on the accessibility of rehabilitation services following road injury. Namibia is one of the five African countries with a fuel tax levy fund (Motor Vehicle Accident Fund, MVAF), a system of case managers, medical care, and case management system for coordination of long-term care. Materials and methods We investigated the availability of physical rehabilitation services to RTI injured in Namibia, through interviews with RTI patients and health care workers. Results Unlike the few other studies done in Sub-Saharan Africa (SSA), most RTI injured individuals in Namibia report they are able to access some rehabilitation following injury. In large measure, this is due to the effective MVAF system which they felt ensures follow up care for many after having an RTI. However, we found that access to rehabilitation is skewed in favour of those living in Windhoek and other urban areas compared with those in non-urban areas. Conclusions The MVAF model seems to enhance access to rehabilitation and is a model which could be replicated in other SSA countries and other low and middle income countries. Implications for rehabilitation Road traffic injuries (RTIs) are a major global public health challenge with over 1.2 million people killed and a high burden of disability and Namibia is one of the worst affected countries globally. There is lack of knowledge on the availability to physical rehabilitation following road injury in Namibia. Our study shows the Motor Vehicle Accident Fund (MVAF) model seems to enhance access to rehabilitation and is a model which could be replicated in Sub-Saharan Africa and other low and middle income countries.

Racial/Ethnic Variation in Veterans Health Administration COVID-19 Vaccine Uptake

IntroductionEquitable COVID-19 vaccine access is imperative to mitigating negative COVID-19 impacts among racial/ethnic minorities. U.S. racial/ethnic minorities have lower COVID-19 vaccination rates than Whites despite higher COVID-19 death/case rates. The Veterans Health Administration provides the unique context of a managed care system with few access barriers. This study evaluates race/ethnicity as a predictor of Veterans Health Administration COVID-19 vaccination.MethodsThe cohort was composed of Veterans Health Administration outpatient users aged ≥65 years (N=3,474,874). COVID-19 vaccination was assessed between December 14, 2020 and February 23, 2021. Multivariable logistic regressions were conducted, controlling for demographics, medical comorbidity, and influenza vaccination history. Proximity to Indian Health Service Contract Health Service Delivery Areas was tested as a moderator. Data analyses were conducted during 2021.ResultsBlacks (OR=1.28, 95% CI=1.17, 1.40), Hispanics (OR=1.15, 95% CI=1.05, 1.25), and Asians (OR=1.21, 95% CI=1.02, 1.43) were more likely than Whites to receive Veterans Health Administration COVID-19 vaccinations. American Indian/Alaska Natives were less likely than Whites to receive Veterans Health Administration COVID-19 vaccinations, but only those residing in Contract Health Service Delivery Area counties (OR= 0.58, 95% CI= 0.47, 0.72). Influenza vaccine history positively predicted COVID-19 vaccine uptake (OR= 2.28, 95% CI=2.22, 2.34).ConclusionsIn the Veterans Health Administration, compared with the general U.S. population, COVID-19 vaccine receipt is higher among most racial/ethnic minority groups than Whites, suggesting reduced vaccination barriers . The Indian Health Service may provide a safety net for American Indian/Alaska Native populations. Addressing vaccination access barriers in non–Veterans Health Administration settings can potentially reduce racial/ethnic disparities.

Організація медичної допомоги при подіях із масовим ураженням людей

Актуальність. Збільшення кількості надзвичайних ситуацій із масовим ураженням людей, зокрема через аварії на транспорті або терористичні напади, призводить до одночасного надходження значної кількості постраждалих осіб до закладів охорони здоров’я та потребує збільшення готовності системи охорони здоров’я до медичного реагування через постійний перегляд і опрацювання Плану реагування та взаємодії під час виникнення надзвичайних ситуацій і ліквідації їх наслідків. Під поняттям «події з масовим ураженням людей» (для закладу охорони здоров’я) у поданій статті розуміють ситуацію, через яку виникає невідповідність між одночасним надходженням значної кількості постраждалих і можливостями надання їм медичної допомоги без впровадження змін у повсякденні форми та методи роботи, на відміну від надзвичайної ситуації потреба залучення зовнішніх ресурсів закладом охорони здоров’я відсутня або мінімальна. Мета. Оптимізація інформаційного забезпечення системи управління медичною допомогою постраждалим при подіях із масовим ураженням людей. Матеріали та методи. Робота ґрунтується на власному досвіді організації та безпосередньому наданні медичної допомоги постраждалим при подіях із масовим ураженням людей і надзвичайних ситуаціях в Україні та за її межами, участі у міжнародних проектах і навчаннях, зокрема під егідою Європейської комісії гуманітарної допомоги та цивільного захисту. Під час проведення дослідження застосовано бібліографічний і семантичний методи пізнання. Узагальнено організаційні аспекти медичного забезпечення 46 випадків масового ураження людей, які відбулись у світі впродовж 1979–2015 рр., із них унаслідок терористичних нападів з використанням вибухових пристроїв — 33 (71,7 %), вогнепальної зброї проти незахищеного цивільного населення — 6 (13 %), пожежі в закладах відпочинку — 3 (6,5 %), сильнодіючих отруйних речовин — 2 (4,3 %) і внаслідок транспортних аварій — 2 (4,3 %). Результати. Організація медичної допомоги постраждалим внаслідок подій із масовим ураженням має ґрунтуватись на принципах 4С кризового менеджменту відповідно до введеного режиму функціонування органів і закладів охорони здоров’я. В системі охорони здоров’я України доцільно впровадити режими, що існують в країнах Європейського Союзу: 1) готовність до можливого надходження значної кількості постраждалих («зелений рівень»); 2) часткова мобілізація («жовтий рівень»); 3) повна мобілізації («червоний рівень»). Первинне медичне сортування постраждалих на догоспітальному етапі передбачає розподіл на дві основні групи: термінові та нетермінові. Нетермінових постраждалих слід доставити до лікарень, які географічно розташовано недалеко від місця події, але не до найближчого закладу, який має бути готовим до надання екстреної медичної допомоги терміновим хворим і тим, хто звернувся самостійно (самозвернення), кількість яких може суттєво перевищувати тих, кого доставлено бригадами екстреної (швидкої) медичної допомоги. До групи управління закладу охорони здоров’я включають відповідальних чергових — лікаря-хірурга та лікаря-анестезіолога. До форм інформаційного забезпечення системи управління надання медичної допомоги на догоспітальному етапу належать: 1) сили та засоби на місці події; 2) розподіл постраждалих на місці події; 3) потреба підсилення догоспітального етапу. На госпітальному етапі визначають можливості проведення хірургічних операцій та кількість вільних лікарняних ліжок: 1) операційний блок; 2) лікарняні ліжка. Висновки. В систему охорони здоров’я України при подіях із масовим ураженням людей доцільно впровадити відповідні рівні функціонування, що використовують в країнах Європейського Союзу. Перерозподіл наявних ресурсів охорони здоров’я при наданні медичної допомоги постраждалим при подіях із масовим ураженням людей на догоспітальному та госпітальному етапах критично важливе для збереження життя та здоров’я постраждалих. Управління надання медичної допомоги при масовому ураженні людей потребує відповідного інформаційного забезпечення догоспітального та госпітального етапів, впровадження галузевої та міжвідомчої взаємодії.

Moral distress in oncology nurses: A qualitative study.

Oncology nursing is a special field of practice containing many factors that cause moral distress. The purpose of this study was to explore the sources of moral distress in oncology nurses. This qualitative phenomenological study was conducted with 14 oncology nurses. The mean interview duration was 30min. Data were analyzed using qualitative inductive content analysis according to the methods of Corbin and Strauss. Four main themes were identified in the study. The first theme, related to the failure of quality of care, includes the failure to provide holistic care and competence problems (not feeling competent in oncology practice). The second theme includes biomedical ethical issues commonly observed in the field of oncology. The third theme includes treatment and care practices, consisting of futile treatments, lack of regulation for 'do not resuscitate' orders and decisions to limit life-prolonging treatment, limited informational authority of nurses, and problems related to educational practices on the patient. The final theme includes problems arising from the health care system and institution's management and the need for regulation to support ethical decisions. Oncology nurses face ethical problems in providing the quality and continuity of care they desire. It is difficult to manage the problems, especially in the end-of-life period. In order to reduce and eliminate these difficulties, it is recommended to make administrative, institutional, legislative, and systemic arrangements.

Are doctors protected enough during COVID-19 in South Asia?

BackgroundThe highly contagious nature of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) places physicians in South Asia at high risk of contracting the infection. Accordingly, we conducted this study to provide an updated account of physician deaths in South Asia during the COVID-19 pandemic and to analyze and compare the different characteristics associated with physician mortality amongst the countries of the region.MethodsWe performed a cross-sectional study by using published news reports on the websites of news agencies from 9 selected countries in South Asia. Our study included only those physicians and doctors who died after contracting COVID-19 from their respective workplaces. All available data about the country of origin, type of, sex, age, medical or surgical specialty, and date of death were included.ResultsThe total number of physician deaths reported due to COVID-19 in our study was 170, with half (87/170, 51%) of the deaths reported from Iran. Male physician deaths were reported to be 145 (145/170 = 85%). Internal Medicine (58.43%) was the most severely affected sub-specialty. The highest physician mortality rate in the general population recorded in Afghanistan (27/1000 deaths). General physicians from India [OR = 11.00(95% CI = 1.06–114.08), p = 0.045] and public sector medical practitioners from Pakistan [aOR = 4.52 (95% CI = 1.18–17.33), p = 0.028] were showing significant mortality when compared with other regions in multivariate logistic regression.ConclusionAn increased number of physician deaths, owing to COVID-19, has been shown in South Asia. This could be due to decreased personal protective equipment and the poor health care management systems of the countries in the region to combat the pandemic. Future studies should provide detailed information of characteristics associated with physician mortalities along with the main complications arising due to the virus.

Exploring potentials of Ayurveda for longevity W.S.R. to Agastya Haritaki Rasayana: A review article

Ayurveda being an established system of medical science that evolved to a comprehensive health care management system, gives equal importance to maintenance and promotion of health by preventing ailments and by curing them. For achieving this, a unique concept of Rasayana was introduced in the Ayurveda classics. Rasayanas being immuno-modulatory in their action are both health promoter as well medicine in the diseased conditions. They are complex formulations containing multiple Aushadha dravyas, that shows a collective as well as personal effects according to their rasa panchaka. Agastya Haritaki Rasayana, a rasayana aushadha yoga, has been proved to be quite useful in multiple disorders of pranavaha srotas as well other systems of the body at various stages of a disease. Being kapha and vata pacifier, it’s utility in disorders pertaining to vitiated kapha and vata is of great use for the mankind. Also, being Rasayana, it has potential to increase the quality and longevity of life.

Exploring the barriers related to the healthcare system in implementing quality intravenous chemotherapy: a qualitative study.

This study aimed to explore barriers related to the healthcare system (HCS) in implementing quality intravenous (IV) chemotherapy (CT) from the perspectives of cancer patients, family caregivers, and healthcare professionals (HCPs). Using an explanatory descriptive qualitative method, this study was conducted in 2019. Forty-one participants (6 patients, 5 family caregivers, 12 oncologists, and 18 nurses) were selected through purposive sampling. In-depth semi-structured interviews and field notes were conducted to collect the data, which were analyzed using qualitative content analysis. Lincoln and Guba's criteria of rigor were employed to ensure the trustworthiness of the study. Data analysis showed two categories, each with three subcategories: barriers related to healthcare professionals (HCPs) comprised of "educational and communication barriers," "failure to establish trust," and "unskilled healthcare professionals"; barriers related to the health care system management (HCSM), which consists of "inadequate physical and care infrastructures to provide services," "lack of support in the disease trajectory from diagnosis to rehabilitation," and "mismanagement of CT wards/procedures." The identification and removal of the barriers related to HCPs and HCSM inroutine care are crucial. Education of and communication with cancer patients and their family caregivers are two important pillars in the quality of intravenous chemotherapy (IV CT) and this education and communication should be based on individualized care and tailored to the unique needs of each patient.

The effect of the outbreak of COVID-19 on respiratory physicians and healthcare in Japan: Serial nationwide surveys by the Japanese Respiratory Society.

BackgroundThe impact of the outbreak of COVID-19 on the work of respiratory physicians in Japan has not yet been evaluated. The study investigates the impact of the outbreak on respiratory physicians’ work over time and identifies problems to be addressed in the future.MethodsWe conducted a web-based survey of respiratory physicians in 848 institutions. The survey comprised 32 questions and four sections: Survey 1 (April 20, 2020), Survey 2 (May 27, 2020), Survey 3 (August 31, 2020), and Survey 4 (December 4, 2020).ResultsThe mean survey response rate was 24.9%, and 502 facilities (59.2%) participated in at least one survey. The proportion of facilities that could perform PCR tests for diagnosis and more than 20 tests per day gradually increased. The percentage capable of managing extracorporeal membrane oxygenation (ECMO) or more than five ventilators did not increase over time. The proportion that reported work overload of 150% or more, stress associated with lack of personal protective equipment (PPE), and harassment or stigma in the surrounding community did not sufficiently improve.ConclusionWhile there was an improvement in expanding the examination system and medical cooperation in the community, there was no indication of enhancement of the critical care management system. The overwork of respiratory physicians, lack of PPE, and harassment and stigma related to COVID-19 did not sufficiently improve and need to be addressed urgently.

The Impact of Surgical Center Volume on Reoperation Risk after Mid Urethral Sling.

We sought to determine whether a center's surgical volume affects patient reoperation rates after mid urethral sling (MUS) surgery. We performed a retrospective cohort study evaluating a large managed care organization from 2005 to 2016. The primary outcome was the MUS reoperation rate. Perioperative factors and reoperation of patients were compared using Wilcoxon rank-sum for continuous variables and chi-square for categorical variables. We estimated the adjusted hazard ratio and the 95% confidence interval of reoperation using Cox proportional hazards model. Within the managed care system, 13,404 primary MUSs were performed at 11 centers over the study period (19/105 center years were considered low volume). Higher-volume centers (>58 procedures/year based on concentration curve) performed 93% of surgeries in this cohort. Overall reoperation risk for patients of higher-volume centers was smaller than those of lower-volume centers, 4.9% vs 9.8% at 9 years (hazard ratio 0.45 [p <0.01]). Risk of reoperation for recurrent stress urinary incontinence (SUI) for patients was lower in the higher-volume centers, 4% vs 9.1% at 9 years (p <0.01). Patient of higher-volume centers were less likely to have a reoperation for mesh exposure 0.2% vs 0.7% (p <0.01) or infection 0% vs 0.2% (p <0.01). Patients who had their MUS surgery at a higher-volume medical center were less likely to have any reoperation including for recurrent SUI, mesh exposure or infection. These findings persisted even when controlling for potential covariates including patient demographics and surgeon volume and specialty.

Early outcomes of primary total hip arthroplasty with use of a smartphone-based care platform: a prospective randomized controlled trial.

The purpose of this study is to evaluate early outcomes with the use of a smartphone-based exercise and educational care management system after total hip arthroplasty (THA) and demonstrate decreased use of in-person physiotherapy (PT). A multicentre, prospective randomized controlled trial was conducted to evaluate a smartphone-based care platform for primary THA. Patients randomized to the control group (198) received the institution's standard of care. Those randomized to the treatment group (167) were provided with a smartwatch and smartphone application. PT use, THA complications, readmissions, emergency department/urgent care visits, and physician office visits were evaluated. Outcome scores include the Hip disability and Osteoarthritis Outcome Score (HOOS, JR), health-related quality-of-life EuroQol five-dimension five-level score (EQ-5D-5L), single leg stance (SLS) test, and the Timed Up and Go (TUG) test. The control group was significantly younger by a mean 3.0 years (SD 9.8 for control, 10.4 for treatment group; p = 0.007), but there were no significant differences between groups in BMI, sex, or preoperative diagnosis. Postoperative PT use was significantly lower in the treatment group (34%) than in the control group (55.4%; p = 0.001). There were no statistically significant differences in complications, readmissions, or outpatient visits. The 90-day outcomes showed no significant differences in mean hip flexion between controls (101° (SD 10.8)) and treatment (100° (SD 11.3); p = 0.507) groups. The HOOS, JR scores were not significantly different between control group (73 points (SD 13.8)) and treatment group (73.6 points (SD 13); p = 0.660). Mean 30-day SLS time was 22.9 seconds (SD 19.8) in the control group and 20.7 seconds (SD 19.5) in the treatment group (p = 0.342). Mean TUG time was 11.8 seconds (SD 5.1) for the control group and 11.9 (SD 5) seconds for the treatment group (p = 0.859). The use of the smartphone care management system demonstrated similar early outcomes to those achieved using traditional care models, along with a significant decrease in PT use. Noninferiority was demonstrated with regard to complications, readmissions, and ED and urgent care visits. This technology allows patients to rehabilitate on a more flexible schedule and avoid unnecessary healthcare visits, as well as potentially reducing overall healthcare costs. Cite this article: Bone Joint J2021;103-B(7 Supple B):91-97.