Patient Engagement Platform Research Articles

Patient Engagement Platforms: How Technology is Impacting Perioperative Communication and Engagement in Total Hip and Knee Arthroplasty

Orthopedic clinics are becoming strained with clinical volume outpacing resources and personnel. Patient engagement platforms can help bridge the communication and engagement gaps between patients and their healthcare teams as total hip and knee arthroplasty transitions to the outpatient setting. These platforms provide a digital infrastructure that allows patients to participate in their healthcare journey while alleviating the burdens on clinic staff. Multiple forms of patient engagement platforms exist but typically fall into one of 3 groups: patient portals, mobile health applications, and chatbots. They all play an important role in enhancing postoperative rehabilitation, patient engagement, and patient care overall. This article explores the spectrum of available patient engagement platforms and examines their advantages, limitations, and documented benefits on clinical outcomes.

Developing eHealth for Home Dialysis: Clinicians' Needs for a Digital Patient Engagement Platform.

eHealth solutions such as digital patient engagement platforms (DPEPs) aim at enhancing communication and collaboration between patients and clinicians. From the clinicians' viewpoint, concerns exist about new information systems (IS) leading to increased workload and interoperability problems. This article aims to support the development and implementation of DPEPs from the end-users' perspective. We studied clinicians' needs for a new DPEP developed to support home dialysis (HD) care. Eight clinicians participated in remote semi-structured interviews. Clinicians had positive expectations for the new DPEP as it could provide an overall picture of patients' status, support patients' self-care, and save time during patient visits. However, they had concerns about successful implementation, changes to workflows, and integration issues. To conclude, it is important to design and agree on changes in work practices, patient care, and complex IS environments when implementing new DPEP solutions in clinics.

Evaluating Health Care Professionals' Readiness for e-Health Adoption in the Context of the COVID-19 Pandemic: A Georgian Perspective.

Background: The COVID-19 pandemic has accelerated the adoption of Electronic health (e-Health), leveraging technologies such as telemedicine, electronic health records, artificial intelligence, and patient engagement platforms. This transformation underscores e-Health's role in providing efficient, patient-centered care. Our study explores health care professionals' readiness for these technologies, emphasizing the need for tailored education in this evolving landscape. Methods: In our study, conducted between February and March 2023, we administered a questionnaire-based survey to 500 staff members (82.4% female, 17.6% male) aged 25-70 from medical universities in Tbilisi, Georgia. The structured questionnaire covered topics such as computer literacy, telemedicine awareness, patient data security, and ethical considerations. We employed SPSS v21.0 for data analysis, encompassing descriptive statistics and thematic analysis of open-ended responses. Results: Our study included 500 participants categorized into five age groups. Notably, 31% considered themselves computer "experts," while 69% rated their skills as "intermediate" or "advanced." Furthermore, 85% used computers professionally, with 33% having practical computer training. Interestingly, 59% expressed interest in information technology training. Regarding e-Health, 15% believed it involves remote communication between health care professionals and patients, while 42% considered it "correct," and 37% "might be correct." Concerning its application in managing patients, opinions varied. In terms of e-Health's integration into Georgia's health care, responses ranged. Regarding patient data safety, participants exhibited diverse views. Finally, opinions on the necessity of informed consent for e-Health applications varied among participants. Conclusions: Our study explores health care professionals' readiness for e-Health adoption during the COVID-19 pandemic. It reveals varying computer literacy levels, a willingness to learn, differing views on e-Health applications, and mixed opinions on its integration into Georgian health care. These findings emphasize the need for clear e-Health terminology, education, tailored approaches, and a focus on data privacy and informed consent. Overall, e-Health's transformative role in modern health care is underscored.

Optimizing CFTR modulator therapy management for cystic fibrosis through the ReX platform.

Cystic fibrosis (CF) is a chronic multi-systemic disease that requires a complex daily treatment regimen. Therefore, there is sub-optimal adherence to CF therapies, and it was shown to impact its clinical and economic burden. Cystic fibrosis transmembrane conductance regulator modulators (CFTRm) are high-cost medications that demonstrated significant benefit in clinical trials. The aim of this study was to evaluate the safety, usability, and efficacy of the ReX platform in medication management of CFTRm for the treatment of people with CF (pwCF). ReX is a patient engagement platform consisting of a cloud-based management system and a cell-enabled handheld device intended to dispense oral medication into the patient's mouth, following a pre-programmed treatment protocol. It provides real-time adherence data to caregivers and timely, personalized reminders to patients. This is a prospective multi-center open study for pwCFs older than 12 years, who had been prescribed CFTRm [elexacaftor/tezacaftor/ivacaftor (ETI) or tezacaftor/ivacaftor (TI)], and provided consent to use ReX platform to receive CFTRm and record their health condition. Study duration was 12-24 months, with clinic visits where physical examination, body mass index (BMI), and pulmonary function tests were performed, and user experience questionnaires were filled in. Ten pwCFs from two CF centers in Israel were included. The mean age was 31.5 years (range 15-74 years); eight were taking ETI and two TI. Median adherence to CFTRm was 97.5% (range 70%-100%) in the first year and 94% (range 84%-99%) in the second year, which is higher than the previously reported CFTRm adherence of ∼80%. No adverse events related to the use of the platform were reported. Patients reported ReX to be valuable to their treatment management and user friendly. Estimated mean forced expiratory volume in 1 s (FEV1%) increased from 74.4% to 80.8% (p = 0.004) over 2 years. Similarly, estimated BMI percentile increased from 53.5 to 59.0 (p < 0.001). Using the ReX platform in medication management of pwCF treated by CFTRm is safe, easy to use, and effective in improving the adherence to treatment and the clinical outcomes. Consequently, this device may potentially reduce costs to healthcare providers. Further larger and long-term studies are required to examine the clinical benefits of the ReX platform.

The Impact of the COVID-19 Pandemic on the Practice of Hip and Knee Arthroplasty

» The COVID-19 global pandemic resulted in unprecedented disruptions in care including massive surgical cancelations, a shift to outpatient surgery, and novel medical risks posed by COVID-19 infection on patients undergoing joint replacement surgery.» Refined patient optimization pathways have facilitated safe, efficient outpatient total joint arthroplasty in patient populations that may not otherwise have been considered eligible.» Rapid innovations emerged to deliver care while minimizing the risk of disease transmission which included the widespread adoption of telemedicine and virtual patient engagement platforms.» The widespread adoption of virtual technology was similarly expanded to resident education and continuing medical activities, which has improved our ability to propagate knowledge and increase access to educational initiatives.» Novel challenges borne of the pandemic include profound personnel shortages and supply chain disruptions that continue to plague efficiencies and quality of care in arthroplasty and require creative, sustainable solutions.

Disconnected: Electronic Patient-Reported Outcome Measure Collection in Orthopaedic Patients is Less Successful Than In-Person Collection at an Urban Safety Net Trauma Center.

Electronic patient-reported outcome measure (E-PROM) collection is a technological advancement that has the potential to facilitate PROM collection in orthopaedic trauma. The purpose of this study was to compare E-PROM versus in-person PROM collection. This is a retrospective comparative study. Urban Level I trauma center. One hundred and fifty consecutive operative orthopaedic trauma patients. The Percent of Normal single assessment numerical evaluation and patient-reported outcomes measurement information system physical function were collected through automated e-mails from an online patient-engagement platform (PatientIQ, Chicago, IL) 2-week, 6-week, 3-month, and 6-month postoperatively. The Percent of Normal was also administered to patients in clinic at the same time intervals. Completion of PROMs; Loss to follow-up. The median clinical follow-up time was 4 months (interquartile range: 1.3-6 months), and 42.7% (64/150) were lost to follow-up. Loss to follow-up was associated with a more disadvantaged area deprivation index [observed difference, 7.0, 95% confidence interval, 1.0 to 13.0; P = 0.01] and noncommercial/no insurance (observed difference 34.8%, confidence interval, 20.9%-45.5%; P < 0.0001). In-person PROM collection was more successful than E-PROM collection at all intervals [2-week (51.3% vs 20.7), 6-week (46.7% vs 20.0%), 3-month (50.0% vs 18.7%), and 6-month (38.0% vs 18.7%), P < 0.0001]. Patients who completed 3-month E-PROMs had longer clinical follow-up (5.2 vs. 3.0 months, P = 0.004) and a trend of being less likely to be lost to follow-up (28.6% vs 45.9%, P = 0.13). E-PROMs were less successful than in-person PROM collection in trauma patients at an urban safety net trauma center. Diagnostic Level III.

Determining Commonalities in the Experiences of Patients with Rare Diseases: A Qualitative Analysis of US Food and Drug Administration Patient Engagement Sessions.

Rare diseases are estimated to affect more than one in ten Americans. However, most patients with a rare disease face significant emotional, physical, and social challenges. To better understand the burden of disease and unmet needs, the US Food and Drug Administration (FDA) conducts and supports multiple patient engagement platforms. We analyzed summaries from these discussions to identify commonalities among patients with disparate rare diseases, the results of which could inform priorities for cross-disease policies and medical product development. We conducted a qualitative analysis of patient engagement session summaries to investigate shared experiences across rare diseases. Cross-disease similarities were identified within four dimensions: product development/regulatory, clinical/physical, social/psychological, and economic/financial. Summaries from 29 rare diseases were included in our analyses. Within the product development/regulatory dimension, we observed that patients and caregivers across rare diseases shared the desire for development of medical products that cured their disease or improved their overall quality of life. In the clinical/physical dimension, we found that patients had numerous common symptoms, including pain and fatigue. In the social/psychological dimension, we observed significant negative impact on mental health. Within the economic/financial dimension, patients and caregivers shared that disease burden caused significant financial hardships. We found remarkable similarities among patients with rare diseases across all four dimensions. Our results indicate that, even among rare diseases with diverse etiologies, patients share numerous commonalties due to their diseases: a lack of effective treatment options, certain physical symptoms, mental health challenges, and financial concerns.

Abstract 091: Efficacy Of A Patient-engagement Platform In Reducing Uncontrolled Hypertension In Community Health Clinics

Introduction: Hypertension affects 47% of US adults and can lead to serious sequelae such as myocardial infarction and stroke when uncontrolled. Over 37 million US adults have blood pressure (BP) higher than 140/90 mmHg. Medication to treat hypertension is effective, yet, approximately 50% of patients do not take medication as prescribed and non-adherence to cardioprotective medications increases a patient’s risk of death from 50% to 80%. Objective: To use a novel patient engagement platform to assist federally qualified health centers (FQHCs) in improving BP control. Methods: We enrolled patients treated at FQHCs in a digital hypertension management program. Patients were prompted to submit their BP and responses to questions about medication adherence and potential side effects of medication either daily or weekly in English or Spanish. The responses were prioritized by level of concern. The clinic reviewed these data, in real-time and provided coaching or treatment changes. We analyzed first and last systolic and diastolic BPs of patients who participated for ≥90 days (range 90-721 days) and considered BP &lt;140/90 mmHg to be controlled. Results: The cohort included 2500 patients, 38.6% male, with a mean age of 53.9 years (range 14-100 years) from 43 FQHCs across the US. Of these patients, 30.7% (768 of 2500) had an initial controlled BP and 61.2% (1529 of 2500) demonstrated a final controlled BP measurement. In patients with an initial uncontrolled BP, 55.4% (959 of 1732) had a controlled final BP. The Spanish language version was used by 551 patients, and in this subgroup, 35.2% (194 of 551) and 70.4% (388 of 551) had controlled BPs on initial and final measurements, respectively, with 66.0% (235 of 356) of initially uncontrolled patients having a controlled final BP. Conclusion: This novel hypertension control program, which used technology to gather and prioritize data, facilitating the clinic’s efficient response, improved BP control rates by over 30% in a real-world, underserved population. BP control was higher in the Spanish-speaking population. Remote digital monitoring with intervention improves clinical outcomes without increasing the overall cost of care, thereby promoting value-based care strategies for chronic diseases such as hypertension.

Disconnected: Electronic Patient-Reported Outcome Measure Collection In Orthopaedic Patients at an Urban Safety-Net Hospital.

Collection of patient-reported outcome measures (PROMs) in orthopaedic patients at safety-net hospitals is challenging. The purpose of this study was to evaluate the success of electronic PROM (E-PROM) collection in this setting. A retrospective review identified 207 consecutive orthopaedic patients undergoing 77 elective arthroplasty procedures and 130 trauma procedures. E-PROMs were collected through automated e-mails from an online patient engagement platform (PatientIQ) at 2 weeks, 6 weeks, and 3 months postoperatively. Patients with trauma received the percentage of normal Single Assessment Numerical Evaluation (SANE) and Patient-Reported Outcomes Measurement Information System-Physical Function (PROMIS-PF). Arthroplasty patients received the Hip/Knee SANE, Hip/Knee Disability and Osteoarthritis Outcome Score-Joint Replacement (HOOS Jr/KOOS Jr), PROMIS Global Physical Health (PROMIS-G-PH), and Veterans RAND 12-Item (VR-12) Health Survey. Compared with patients with trauma, arthroplasty patients were older (median difference 18.0 years; 95% confidence interval [CI] 12.0-22.0; P < 0.0001), more likely to be Hispanic/Black (proportional difference 16.9%; CI 2.8-30.3%; P = 0.02), more likely to have noncommercial or no insurance (proportional difference 34.0%; CI 23.2-43.0%; P < 0.001), and did not differ in Area Deprivation Index or E-PROM completion at each time point. E-PROMs were completed at 2 weeks, 6 weeks, and 3 months by 25.1% (52 of 207), 24.6% (51 of 207), and 21.7% (45 of 207) of all patients, respectively. Trauma and arthroplasty patients had a similar rate of partial E-PROM completion. Patients who completed 3-month E-PROMs were less likely to be Hispanic/Black (PD -16.4%; CI -31.0 to -0.2%; P < 0.04); less likely to have noncommercial/no insurance (PD -20.0%; CI -35.5 to -4.5%; P = 0.01); and did not differ in age, sex, Area Deprivation Index, or procedure type. The low collection rate of E-PROMs from orthopaedic patients at safety-net hospitals should be weighed against their costs. E-PROM collection may exacerbate disparities in PROM collection among certain patient populations. Diagnostic Level III.

Chitranjan S. Ranawat Award: Tourniquet Use Does Not Impact Trajectory of Total Knee Arthroplasty Early Recovery: A Prospective, Randomized Controlled Trial

BackgroundThe impact of tourniquet use on recovery after total knee arthroplasty (TKA) remains controversial. The purpose of this prospective, single blinded, randomized controlled trial was to investigate the effect of tourniquet use on early recovery after TKA using a smartphone app–based patient engagement platform (PEP) with a wrist-based activity monitor to obtain more robust data on early recovery. MethodsThere were 107 patients undergoing primary TKA for osteoarthritis who were enrolled (54 tourniquet [TQ+]; 53 no tourniquet [TQ−]). All patients utilized a PEP and wrist-based activity sensor for 2 weeks preoperatively and 90 days postoperatively to collect Visual Analog Scale (VAS) pain scores and opioid consumption, as well as weekly Oxford Knee Score (OKS) and monthly Forgotten Joint Score (FJS). There was no difference in demographics between groups. Formal physical therapy assessments were performed preoperatively and 3 months postoperatively. Independent sample t-tests were used for continuous data and Chi-square and Fisher’s exact tests were used for discrete data. ResultsTourniquet use did not have a statistically significant impact on daily VAS pain or opioid consumption during the first 30 days postoperatively (P > .05). Tourniquet use did not have a significant impact on OKS or FJS at 30 or 90 days postoperatively (P > .05), or on performance of formal physical therapy testing at 3 months postoperatively (P > .05). ConclusionUsing a digital technology to collect daily patient data, we found that tourniquet use has no clinically significant negative impact on pain and function in the first 90 days after primary TKA.

EPCO-10. SYSTEMS BIOLOGY-BASED THERAPEUTIC PREDICTIONS WITH GBMSYGNAL AND CLINICAL CORRELATES IN THE REAL-WORLD LONGITUDINAL OUTCOMES REGISTRY XCELSIOR

Abstract Glioblastoma is an aggressive disease with multiple disrupted signaling networks in the same tumor, demanding the development of personalized combination regimens. Using SYstems Genetics Network AnaLysis we analyzed TCGA multiomics datasets for 422 glioblastoma patients to generate a predictive disease network model (gbmSYGNAL). This model seeks to uncover how subsets of mutations causally modulate regulators (transcription factors, miRNAs, etc.) that mechanistically regulate gene modules (“regulons”) associated with disease progression. Using the real-world registry XCELSIOR (NCT03793088), we identified 55 anti-cancer therapies utilized in glioblastoma treatment (N = 354 patients) and associated them with positive or negative regulon activity within individual patients across the TCGA cohort. A median of 12 regulons were targeted by each drug. Interestingly, nilotinib targeted only 5 regulons but they were found to be active in 38% of patients and regulons overactive in &amp;gt;35% of patients were targeted by repurposed anti-cancer drugs including celecoxib, hydroxychloroquine, and tocilizumab. Standard-of-care treatments lomustine and bevacizumab were predicted to be active in only 28% and 23% of patients, respectively. Using gbmSYGNAL, we then prioritized drugs for 12 additional patients from the XCELSIOR registry. Median overactive regulons per patient was 110 (range 55-254) represented by a median 28 molecular targets (range 17-37). Surprisingly, regulons targeted by metformin were predicted to be overactive in all patients. Certain regulons displayed a binary pattern (high “on” activity or completely “off” per patient) including those targeted by pemetrexed, pembrolizumab, and valproic acid while others showed a gradient of activity across patients including selinexor, panobinostat, palbociclib, and alpelisib. Systems biology analysis of commercially available NGS data combined with the XCELSIOR direct patient engagement platform yielded therapeutically actionable insights for glioblastoma patients in real time. Correlation with clinical outcomes is ongoing for ~50 additional patients and will be presented at the meeting.

Use of a patient engagement technology platform improves gynecologic oncology patient outcomes in the perioperative setting (001)

Objectives: Technology can now be used through patient engagement platforms (PEPs) to allow patients to interact with their healthcare providers in order to increase education, assess and manage symptoms, monitor outcomes, and address questions/concerns. The objective of this study was to evaluate the impact of a mobile health patient engagement platform (PEP) on postoperative outcomes among gynecologic oncology patients undergoing surgery on an enhanced recovery protocol (ERP). Methods: All gynecologic oncology patients undergoing surgery on the ERP were approached from July 2019 to May 2021. The patients were enrolled in a PEP, which can be accessed by computer, tablet, or smartphone and provide enhanced pre and postoperative patient education and remote patient monitoring. Patients who elected to participate were provided with targeted education based on their age and comorbid conditions and were asked to complete daily health checks in the postoperative period. Patients reporting problems in the health check were given personalized education for minor problems or prompted to call the healthcare team for more serious issues. Age, race, body mass index (BMI), Carlson comorbidity index (CCI), surgical complexity, insurance status, length-of-stay (LOS), re-admission rates, surgical site infections, and use of the PEP were evaluated. Analysis was performed using SPSS v.26. Results: A total of 682 women met inclusion criteria during the study time. Of them, 347 were in the PEP group and 335 were in the control group (ERP only group). Patients in the PEP group had a significantly lower LOS (2.9 vs 3.6 days; p<0.01) and lower re-admission rate (4.3% vs 8.6%; p<0.01) than the control group. There was no difference in surgical site infections (1.1 vs 0.9%; p=0.4). Demographics and other factors, including race, BMI, CCI, gynecologic cancer diagnosis, surgical complexity, and insurance status, were not different between the PEP and control groups. Conclusions: The use of PEP in our gynecologic oncology patient population decreased LOS by nearly one day despite an absence of differences in other demographic and surgical factors. Furthermore, there was a 50% reduction in re-admission rates in the PEP group. The use of PEP allows healthcare professionals to engage, evaluate, and treat patients in a way that improves perioperative care. Objectives: Technology can now be used through patient engagement platforms (PEPs) to allow patients to interact with their healthcare providers in order to increase education, assess and manage symptoms, monitor outcomes, and address questions/concerns. The objective of this study was to evaluate the impact of a mobile health patient engagement platform (PEP) on postoperative outcomes among gynecologic oncology patients undergoing surgery on an enhanced recovery protocol (ERP). Methods: All gynecologic oncology patients undergoing surgery on the ERP were approached from July 2019 to May 2021. The patients were enrolled in a PEP, which can be accessed by computer, tablet, or smartphone and provide enhanced pre and postoperative patient education and remote patient monitoring. Patients who elected to participate were provided with targeted education based on their age and comorbid conditions and were asked to complete daily health checks in the postoperative period. Patients reporting problems in the health check were given personalized education for minor problems or prompted to call the healthcare team for more serious issues. Age, race, body mass index (BMI), Carlson comorbidity index (CCI), surgical complexity, insurance status, length-of-stay (LOS), re-admission rates, surgical site infections, and use of the PEP were evaluated. Analysis was performed using SPSS v.26. Results: A total of 682 women met inclusion criteria during the study time. Of them, 347 were in the PEP group and 335 were in the control group (ERP only group). Patients in the PEP group had a significantly lower LOS (2.9 vs 3.6 days; p<0.01) and lower re-admission rate (4.3% vs 8.6%; p<0.01) than the control group. There was no difference in surgical site infections (1.1 vs 0.9%; p=0.4). Demographics and other factors, including race, BMI, CCI, gynecologic cancer diagnosis, surgical complexity, and insurance status, were not different between the PEP and control groups. Conclusions: The use of PEP in our gynecologic oncology patient population decreased LOS by nearly one day despite an absence of differences in other demographic and surgical factors. Furthermore, there was a 50% reduction in re-admission rates in the PEP group. The use of PEP allows healthcare professionals to engage, evaluate, and treat patients in a way that improves perioperative care.

The role of commercially available smartphone apps and wearable devices in monitoring patients after total knee arthroplasty: a systematic review.

PurposeCommercially available smartphone apps and wearable devices have proven valuable in a variety of clinical settings, yet their utility in measuring physical activity and monitoring patient status following total knee arthroplasty (TKA) remains unclear.MethodsA systematic review was performed to assess the evidence supporting the use of smartphone apps and wearable devices to assist rehabilitation interventions following TKA. A search was conducted in the PubMed, Cochrane, Medline, and Web of Science databases in September 2021.ResultsOne hundred and seventy-six studies were retrieved, of which 15 met inclusion criteria, including 6 randomized control trials. Four of these studies utilized smartphone apps, seven utilized wearable devices, and four utilized a combination of both. A total of 1607 TKA patients participated in the included studies. For primary outcomes, three reported on device accuracy, three on recovery prediction, two on functional recovery, two on physical activity promotion, two on patient compliance, two on pain control, and one on healthcare utilization.ConclusionCommercially available smartphone apps and wearable devices were shown to capably monitor physical activity and improve patient engagement following TKA, making them potentially viable adjuncts or replacements to traditional rehabilitation programs. Components of interventions such as step goals, app-based patient engagement platforms, and patient-specific benchmarks for recovery may improve effectiveness. However, future research should focus on the economics of implementation, long-term outcomes, and optimization of compliance and accuracy when using these devices.

Insights and Strategies to Revive Brachytherapy Using Social Media: A Google Trends Analysis.

Introduction: The utilization and public awareness of brachytherapy are both declining. Social media has an increasing presence in health promotions. As regards cancer care, social media has been successfully used as a platform for information dissemination, psychosocial support, and patient engagement and empowerment.Methods and materials: Using Google Trends (Google LLC, Mountain View, CA, USA), we analyzed the impacts on the public interest of three brachytherapy-related social media campaigns/publicity events and compared and contrasted them with three other campaigns/publicity events. We used descriptive statistics (mean ± standard deviation (SD)) to describe the search results, independent t-tests to compare means before and after campaigns/announcements for short-term effects, and one-way ANOVA (or Kruskal-Wallis test when appropriate) to compare mean values across distinct time periods for long-term effects.Results: We identified three major types of social media campaigns/events: those that have a short-term impact but little long-term impact, those that have both short-term and long-term impacts, and those with little short-term or long-term impact. We examined campaigns with significant and lasting impacts and noticed that they tend to be celebrity-related/celebrity-endorsed, focused on sharing personal experiences, and occur with regular frequency.Conclusions: To increase public awareness of brachytherapy, the American Brachytherapy Society (ABS) can consider tie-ins with events and people with high search traffic (such as Breast Cancer Awareness Month), having celebrities/influencers who were treated with brachytherapy to provide testimonials, encouraging patient engagement and sharing of their experiences with brachytherapy on social media, and setting up recurring brachytherapy publicity events.

0361 PennPALS: An Innovative, Bidirectional Text Messaging System Using PAP Usage Data to Increase Patient Adherence with PAP Therapy

Abstract Introduction Cloud-based systems that collect PAP data provide patients and providers with near real-time usage information, but a system that identifies/intervenes with patients at risk of PAP non-adherence has not been available to date. The Penn PAP Automated Learning System (PennPALS) is an automated, bidirectional text messaging system that uses PAP data to initiate text messaging conversations to patients in a timely manner. Methods PennPALS was created using Way to Health, an evidence-based patient engagement platform, to leverage PAP data, such as daily average hours of use and time spent with a large mask leak, to identify and initiate automated text messages to help patients troubleshoot issues. Depending on their responses, patients were given a pre-defined recommendation via text or escalated to a clinical provider contacting them via phone-call. Two 30-day pilots were conducted, which collectively enrolled 33 patients who were prescribed PAP for the first time. Results Most patients were White, Non-Hispanic (54.8%, n=17), males (64.5%, n=20), with a mean age of 52 years. Two patients did not receive a PAP machine by the end of the pilot. PennPALS engaged patients via text message 115 times. Of the 31 patients who started PAP, 7 (22.6%) were adherent from the start of enrollment and only received positive enforcement text messaging. Across the 24 (77.4%) patients that experienced issues, there were 58 text message conversations, which resulted in 32 clinical escalations. Twenty-one (67.7%) patients triggered text messaging interventions for using PAP for &amp;lt; 4 hours/night on average over a 7-day period or experiencing a large mask leak, n=10 (32.3%) and n=11 (35.5%) respectively. At 30-days, 17 (70.8%) of the 24 patients were adherent (i.e. using their PAP at least 4 hours/night on average over the last 7-days). Patient feedback was generally favorable with a Net promoter score (likelihood to recommend) of 68.4 (n=19). Conclusion PennPALS effectively identified/intervened with patients at risk of non-adherence to PAP therapy, and the bidirectional text messaging system helped patients become adherent in the first 30 days of treatment. Further testing and longer-term monitoring is needed to examine the effectiveness of PennPALS on long-term PAP adherence. Support (If Any)

Protocol for the IMPACT Trial: Improving Healthcare Outcomes in American Transplant Recipients Using Culturally-Tailored Novel Technology

Kidney transplant (KT) recipients face post-transplant health issues. Immunosuppressive agents can cause hyperlipidemia, hypertension, post-transplant diabetes, and glomerulopathy. Post-transplant weight gain and decreased activity are associated with poor quality of life, sleep, and cardiometabolic outcomes. This study will test the feasibility and acceptability of a culturally tailored diet and exercise intervention for KT patients delivered immediately post-transplant using novel technology. A registered dietitian nutritionist (RDN) and physical rehabilitation therapist will examine participants' cultural background, preferences, and health-related obstacles (with consultation from the transplant team) to create an individualized exercise and meal plan. The RDN will provide medical nutrition therapy via the nutrition care process throughout the course of the intervention. The Twistle Patient Engagement Platform will be used to deliver and collect survey data, communicate with participants, and promote retention. Outcomes to be assessed include intervention feasibility and acceptability and intervention efficacy on patients' adherence, medical, quality of life, and occupational outcomes.

Do Patient Engagement Platforms in Total Joint Arthroplasty Improve Patient-Reported Outcomes?

Web-based patient engagement portals are increasing in popularity after total hip and knee arthroplasty (THA and TKA). The literature is mixed regarding patient utilization of these modalities and potential clinical benefit. We sought to determine which demographic factors are associated with increased platform participation and to quantify the impact of a web-based patient portal on patient-reported outcome measures (PROMs). We performed a retrospective analysis of consecutive primary THA (n= 554) and TKA (n= 485) at a single academic institution with minimum follow-up of 12 months. Patients were divided into those who opted-in and those who opted-out of portal use. Global health and joint-specific PROMs were collected preoperatively and postoperatively. Linear mixed effects modeling, bivariate analysis, and logisticregression were utilized. Of the 1039 included patients, 60.6% (336) THA and 62.7% (304) TKA patients enrolled in the portal. Those who opted-in were younger (P < .001, P < .003), had higher body mass index (P= .024, P= .011), and had a higher household income (P < .001, P < .001) in THA and TKA cohorts, respectively. Portal participation in the TKA but not the THA cohort was associated with significant improvement in physical function (P= .017) and joint-specific function (P= .045). For THA patients who opted-in, increased portal logins were associated with more rapid improvement and higher functional scores (P= .013). There is an inherent difference between patients who opt-in to and those who opt-out of web-based portals. Added resources and support provided by portals may translate to improved PROMs for TKA patients but not THA patients.

Ambulatory Hip and Knee Replacement Outcomes During COVID-19 Outbreak in Washington State

Introduction The first case of COVID-19 in the U.S. was diagnosed on January 19th, 2020 in Washington State and evidence suggested that the virus was circulating in Washington prior to this. Elective joint replacements were suspended on March 19th, 2020 with the goal of preserving resources and protecting patients and workers. This pilot study evaluates a group of patients who underwent elective joint replacement during the initial surge of COVID-19 and before the shutdown of elective surgeries to examine the patient experience of elective joint arthroplasty during a COVID-19 surge. All patients participated in an outpatient joint replacement program utilizing a dedicated patient engagement platform which enabled the investigation of Patient Reported Outcome Measures (PROMs), COVID-19 surveys, as well as patient satisfaction outcomes. Methods This observational study reviewed 282 patients who underwent hip and knee arthroplasty in Washington State during the COVID-19 surge between January and March 2020. Surgeries were done by surgeons experienced in outpatient techniques using a standardized protocol. Patients registered on a dedicated cloud platform (The SwiftPath Program, LLC). Patient education emphasized the benefits of early discharge and recovery at home. The patient experience included shared-decision-making and a vetted risk stratification algorithm. Homecare monitoring allowed for notifications to the care team as well as opiate tracking, recovery milestones, and PROs. Patients responded to postoperative homecare queries, satisfaction surveys, and standardized PROs surveys (HOOS JR., KOOS JR., PROMIS) at baseline and routine post-op intervals out to 6 weeks. A follow-up “COVID-19 survey” was also used to specifically evaluate exposure to and complications from potential COVID-19 infection. Results There were 254 patients out of 282 (90.0%) who registered and had partially completed the data collection. The average age of patients was 67.7 years old (range 30 – 91). Fifty-nine patients (23.2%) completed HOOS JR. and KOOS JR. data, and of these patients, 46 were knee replacements, and 13 were hip replacements. Every patient who responded both to the preoperative and postoperative HOOS JR. and KOOS JR. questionnaires had improved scores by six weeks postoperatively. Of the 180 patients who responded to the COVID-19 survey, none reported viral symptoms or developed COVID-19. Patients indicated limited physical therapy access, but recovery was not impacted. The average surgery satisfaction during the pandemic was 9.3/10.0. Conclusion An online patient engagement platform can help monitor the clinical course, PROs as well as any virus-related illnesses in patients undergoing TJA. Information from PROs can be used to evaluate outcomes during a pandemic. Additional studies should focus on larger numbers of patients and compare PROs with clinical outcomes to help document the safety of performing elective surgeries during pandemics.

PO48: Insights and Strategies to Revive Brachytherapy Using Social Media: A Google Trends Analysis

Purpose: The utilization and public awareness of brachytherapy are both declining. Social media has an increasing presence in health promotions. Particularly regarding cancer, social media has been shown as a platform for information dissemination, psychosocial support, and patient engagement and empowerment. Using Google Trends, we analyzed the impacts on public interest of three brachytherapy-related social media campaigns/publicity event and compared and contrasted them with three other campaigns/publicity events with varying levels of impacts.

Patient Engagement Technologies in Orthopaedics: What They Are, What They Offer, and Impact.

The modern era is an increasingly digital and connected world. Most of the Americans now use a smartphone irrespective of age or income level. As smartphone technologies become ubiquitous, there is tremendous interest and growth in mobile health applications. One segment of these new technologies are the so-called patient engagement platforms. These technologies present a host of features that may improve care. This article provides an introduction to this growing technology sector, offers insight into what they may offer patients and surgeons, and discusses how to evaluate various platforms.