Abstract
Introduction
Employer-sponsored travel surgery programs for commonly performed procedures like total joint arthroplasty (TJA) are increasing, as employers try to more effectively manage the healthcare costs of their employees. This new approach by employers to direct their employees to designated “Centers of Excellence” (COEs) creates a need to characterize the “travel patient” population that commutes long distances to receive their surgical care and returns home for their rehab shortly after surgery. Electronic patient rehabilitation platforms (EPRA) facilitate communication, patient navigation, and care coordination across this complex episode of care and may contribute to improved outcomes after TJA. The aim of this study is to evaluate patient satisfaction, functional outcomes and engagement with the use of an EPRA among two TJA cohorts: 1) travel and 2) non-travel TJA patients.
Methods
A retrospective review was performed on total knee (TKA) and total hip (THA) arthroplasty patients at a single institution during the first 6 months following implementation of an EPRA. All patients were offered internet based access to an EPRA which provided instant messaging with the care team, algorithmic navigation of the patient during the pre and post-op phases, and access to an extensive library of educational videos regarding their surgery, rehab, and FAQs. Primary outcome measures were the pre-op and 12 week post op HOOS Jr. and KOOS Jr. Patient satisfaction at 12 weeks after surgery and engagement metrics for the EPRA were also examined. Cases were separated into two groups: travel and non-travel, and the groups were compared in terms of engagement, improvement in functional outcomes, and patient satisfaction. Chi-square test and t-test statistics were used for analysis.
Results
634 TJA cases (100 travel; 534 non-travel) were included in this study. Age and BMI differed significantly between these cohorts (p<0.001). The mean age and BMI were 59.17 and 33.01, respectively for travel patients and 69.27 and 29.56, respectively for non-travel patients. 97% of the travel patients initially opted-in to use the electronic rehabilitation program compared to 87.6% of the non-travel patients. The number of travel patients logging in, watching videos, and messaging was significantly higher than that of non-travel patients (p<0.01). On average, travel patients generated double the number of sessions than non-travel patients (71.5 vs 31.5, p<0.001).
Among TKA cases, travel patients reported significantly lower pre-op mean KOOS Jr. scores than non-travel patients (43.11 vs. 47.78, p< 0.01). By 12 weeks, there was no difference between the groups (67.11 vs. 70.05, p=0.15). THA cases exhibited similar increases in patient reported outcomes(PROs). Mean pre-op HOOS Jr scores for travel and non-travel patients were 42.64 and 48.16 respectively (p=0.07) and mean post-op HOOS Jr. scores at 12 weeks were 75.93 and 80.12, respectively (p=0.15). Comparing 12 week procedure satisfaction (0–5), travel THA patients reported significantly higher mean satisfaction than non-travel THA cases (4.93 vs 4.32, p<0.001). There was no difference in satisfaction between travel TKA and non-travel TKA cases (4.31 vs 4.35, p=0.85).
Conclusion
This study revealed higher engagement among travel patients in comparison to non-travel patients as measured by utilization of EPRA. Patients participating in these programs are typically incentivized financially in terms of enhanced insurance coverage and elimination of out-of-pocket expenses when they obtain care at an employer designated COE which may contribute to this increased degree of engagement. Increased utilization of EPRA may have also contributed to higher 12 week patient satisfaction. Despite the logistical challenges of travel TJA surgery, the EPRA used in this study appears to facilitate effective patient navigation and care coordination in the travel patient population, resulting in patient reported outcomes and satisfaction that is comparable to our non-travel patient population. Considering the projected increased growth of these employer directed COE programs, further understanding of these travel surgery patients and the role of electronic patient engagement platforms and telehealth technologies is warranted.
For figures, tables, or references, please contact authors directly.
