Remote Monitoring Significantly Decreases Rehospitalizations in Arthroplasty Patients

Remote monitoring in patients who underwent joint arthroplasty led to a fourfold decrease in rehospitalizations, a randomized trial found. According to the researchers, this may have been due to goal setting and connection to the care team.

The use of telemedicine surged amid the COVID-19 pandemic, and its usability and convenience has left patients and providers alike wondering what its future may look like post-pandemic. It may seem more difficult to implement in some specialties compared to others, including orthopedics. While orthopedic surgeries have not yet moved to the patient’s home, it appears that postoperative patient monitoring has the potential to go remote.

Hip and knee arthroplasty is the most widely performed inpatient surgical procedure among Medicare beneficiaries, the authors note in their study.

“There are great opportunities for health systems and clinicians to improve the quality and value of care for patients getting hip and knee joint replacement surgery, and some of the most important advances are focused on what happens when patients return home,” said lead study author Shivan Mehta, MD, associate chief innovation officer at Penn Medicine, in a press release. “Technology, behavioral science insights, and care redesign can help to improve care at home and prevent patients from coming back to the hospital unnecessarily.”

Patients undergoing hip or knee arthroplasty at one of two urban hospitals at an academic health system were randomized to receive either usual care (n=153) or remote monitoring (n=147), which was offered preoperatively and spanned hospital discharge through 45 days postdischarge. Patients in the remote monitoring group who agreed received a wearable activity monitor that measured step count, messages regarding postoperative goals and milestones, pain score tracking, and connection to clinicians. The intervention group was also randomized to either remote monitoring alone or remote monitoring plus gamification and social support. Discharge status was the main outcome, while average daily step count and rehospitalizations were evaluated as secondary outcomes.

Final analysis included 124 usual care and 118 remote monitoring patients. the median age was 66 years (interquartile range, 58-73 years), and 78.1% of patients were female. In the intervention group, 81.4% of patients consented to receive remote monitoring.

Although rates of discharge to home did not largely differ between the usual care (57.3%) and remote monitoring groups (56.8%), patients who received remote monitoring had a significantly lower rehospitalization rate compared to usual care patients (3.4% vs. 12.2%). Daily average step counts did not largely differ between the two remote monitoring groups.

“Hospital readmission is a metric of low quality care and recovery and high cost for patients and health care providers,” said study coauthor Eric Hume, MD, associate clinical professor of Orthopaedic Surgery and director of Quality and Safety in Orthopaedic Surgery at Penn Medicine. “Clinicians always respond to poor quality, of course, but accountable care organizations and those working under bundled payment agreements are very interested in value–the ratio of quality over cost. Work like this points to the benefit of technology as a way to support quality care.”

Dr. Mehta said that interventions beyond the 45-day threshold could perhaps increase postoperative activity levels.

The study was published in JAMA Network Open.