Home to Stay: An Integrated Monitoring System Using a Mobile App to Support Patients at Home Following Colorectal Surgery

Christine J S Keng, Alifiya Goriawala, Saira Rashid, Rachel Goldstein, Selina Schmocker, Alexandra Easson, Erin Kennedy, Christine J S Keng, Alifiya Goriawala, Saira Rashid, Rachel Goldstein, Selina Schmocker, Alexandra Easson, Erin Kennedy

Abstract

Background: Patients undergoing colorectal surgery are vulnerable during their transition from hospital to home and require increased support following discharge from hospital. Study objectives were to perform an initial assessment of patient uptake, outcomes, and satisfaction with an integrated discharge monitoring system called Home to Stay.

Methods: The intervention was an integrated discharge monitoring system that uses a mobile app platform. Patients downloaded the app prior to discharge from hospital and received a Daily Health Check day #1 to #14, #21, and #30. Patient responses' were accessed by the health-care team via secure web site, and extreme responses were "flagged" to indicate that a follow-up telephone call was necessary. Primary outcomes were patient uptake, Quality of Recovery scores and satisfaction with the program. Secondary outcomes were 30-day emergency room (ER) visits and readmissions.

Results: One hundred and thirty-two patients were invited to participate and 106 accepted. Of these, 93 used the app at least once. The mean overall score on the Quality of Recovery Scale increased significantly from day 1 to day 14. Patient satisfaction with the app was high, with 92% of patients reporting overall satisfaction as good or excellent. The 30-day readmission rate was 6% and was lower than the 30-day readmission rate of 18% reported for the 4 months prior to the start of the study.

Conclusions: The Home to Stay Program to support patients at home after colorectal surgery is feasible with high patient uptake and satisfaction. This program has the potential to reduce 30-day readmissions, however further studies are required.

Keywords: colorectal surgery; mobile application; patient satisfaction; postoperative recovery.

Conflict of interest statement

Declaration of Conflicting Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

© The Author(s) 2020.

References

    1. Coleman EA, Smith JD, Raha D, Min SJ. Posthospital medication discrepancies: prevalence and contributing factors. Arch Intern Med. 2005;165:1842–7.
    1. Dudas V, Bookwalter T, Kerr KM, Pantilat SZ. The impact of follow-up telephone calls to patients after hospitalization. Am J Med. 2001;111:26S–30S.
    1. Forster AJ, Murff HJ, Peterson JF, Gandhi TK, Bates DW. The incidence and severity of adverse events affecting patients after discharge from the hospital. Ann Intern Med. 2003;138:161–7.
    1. Weaver FM, Perloff L, Waters T. Patients’ and caregivers’ transition from hospital to home: needs and recommendations. Home Health Care Serv Q. 1998;17:27–48.
    1. Guinier D, Mantion GA, Alves A, Kwiatkowski F, Slim K, Panis Y, et al. Risk factors of unplanned readmission after colorectal surgery: a prospective, multicenter study. Dis Colon Rectum. 2007;50:1316–23.
    1. Li LT, Mills WL, White DL, Li A, Gutierrez AM, Berger DH, et al. Causes and prevalence of unplanned readmissions after colorectal surgery: a systematic review and meta-analysis. J Am Geriatr Soc. 2013;61:1175–81.
    1. Wick EC, Shore AD, Hirose K, Ibrahim AM, Gearhart SL, Efron J, et al. Readmission rates and cost following colorectal surgery. Dis Colon Rectum. 2011;54:1475–9.
    1. Ceppa EP, Pitt HA, Nakeeb A, Schmidt CM, Zyromski NJ, House MG, et al. Reducing readmissions after pancreatectomy: limiting complications and coordinating the care continuum. J Am Coll Surg. 2015;221:708–16.
    1. Burke RE, Coleman EA. Interventions to decrease hospital readmissions: keys for cost-effectiveness. JAMA Int Med. 2013;173:695–8.
    1. Jones CE, Hollis RH, Wahl TS, Oriel BS, Itani KM, Morris MS, et al. Transitional care interventions and hospital readmissions in surgical populations: a systematic review. Am J Surg. 2016;212:327–35.
    1. Jack BW, Chetty VK, Anthony D, Greenwald JL, Sanchez GM, Johnson AE, et al. A reengineered hospital discharge program to decrease rehospitalization: a randomized trial. Ann Intern Med. 2009;150:178–87.
    1. Balaban RB, Weissman JS, Samuel PA, Woolhandler S. Redefining and redesigning hospital discharge to enhance patient care: a randomized controlled study. J Gen Intern Med. 2008;23:1228–33.
    1. Young JM, Butow PN, Walsh J, Durcinoska I, Dobbins TA, Rodwell L, et al. Multicenter randomized trial of centralized nurse-led telephone-based care coordination to improve outcomes after surgical resection for colorectal cancer: the CONNECT intervention. J Clin Oncol. 2013;31:3585–91.
    1. CATALYST. Smartphone Behaviour in Canada and the Implications for Marketers in 2016 Catalyst Canada. 2016.
    1. Li LT, Mills WL, Gutierrez AM, Herman LI, Berger DH, Naik AD. A patient-centered early warning system to prevent readmission after colorectal surgery: a national consensus using the Delphi method. J Am Coll Surg. 2013;216:210–6 e6.
    1. Stark PA, Myles PS, Burke JA. Development and psychometric evaluation of a postoperative quality of recovery score: the QoR-15. Anesthesiology. 2013;118:1332–40.
    1. Warren-Stomberg M, Jacobsson J, Brattwall M, Jildenstal P. At-home monitoring after surgery/anaesthesia—a challenge. J Eval Clin Pract. 2016;22:882–6.
    1. Scott AR, Alore EA, Naik AD, Berger DH, Suliburk JW. Mixed-methods analysis of factors impacting use of a postoperative mHealth app. JMIR Mhealth Uhealth. 2017;5:e11.
    1. De La Cruz Monroy MFI, Mosahebi A. The use of smartphone applications (Apps) for enhancing communication with surgical patients: a systematic review of the literature. Surg Innovat. 2019;26:244–59.
    1. Gunter RL, Chouinard S, Fernandes-Taylor S, Wiseman JT, Clarkson S, Bennett K, et al. Current use of telemedicine for post-discharge surgical care: a systematic review. J Am Coll Surg. 2016;222:915–27.
    1. Symer MM, Abelson JS, Milsom J, McClure B, Yeo HL A mobile health application to track patients after gastrointestinal surgery: results from a pilot study. J Gastrointest Surg. 2017;21:1500–5.
    1. Lin H, Wu X. Intervention strategies for improving patient adherence to follow-up in the era of mobile information technology: a systematic review and meta-analysis. PloS One. 2014;9:e104266.
    1. Nagle D, Pare T, Keenan E, Marcet K, Tizio S, Poylin V. Ileostomy pathway virtually eliminates readmissions for dehydration in new ostomates. Dis Colon Rectum. 2012;55:1266–72.

Source: PubMed

Szponzorok és közreműködők

Egészségi állapot

Kábítószer-beavatkozások

3
Iratkozz fel