Can digital engagement improve outcomes for total joint replacements?

Background: Patient activation and engagement can improve outcomes of medical and surgical care by increasing involvement of patients in their care plan. We designed a digital engagement tool to improve surgical cancellation and post-surgical outcomes for adult patients undergoing total joint replacements by providing patient education materials via email or text, in small increments throughout the perioperative period. Methods: We assessed the tool's impact using a quasi-experimental design comparing patients scheduled for surgery January-June 2017 (pre-intervention) versus January-June 2018 (post-intervention). Post-intervention patients with digital contact information in the medical record were automatically enrolled. We extracted de-identified administrative data for all patients during both time periods and utilized an intent-to-treat approach including all post-intervention patients regardless of enrollment. Surgical cancellation and post-surgical outcomes (length of stay, discharge to home and revisits and readmissions) were compared between periods using adjusted regression models. We also examined associations between measures of engagement with the intervention and outcomes. Results: A total of 2027 joint replacement patients were included (720 hip replacements; 1307 knee replacements). Adjusting for gender, age and insurance type, both hip and knee patients in the post-intervention group were more likely to have a cancelled surgery, but cancellations were less likely to be on the day of surgery compared to pre-intervention patients. Post-intervention patients were also less likely to have length of stay >2 days. Forty- three per cent of hip and 47% of knee patients in the post-period received the intervention and most were highly engaged. Higher engagement was associated with lower odds of surgical cancellation, shorter stays and higher odds of discharge home. Conclusion: Findings suggest that utilization of a digital patient engagement tool translates into improved hospital efficiency and patient outcomes, particularly for those highly engaged.