Total Knee Replacement and the Effect of Technology on Cocreation for Improved Outcomes and Delivery: Qualitative Multi-Stakeholder Study

Abstract

BackgroundThe growth in patient-centered care delivery combined with the rising costs of health care have perhaps not unsurprisingly been matched by a proliferation of patient-centered technology. This paper takes a multistakeholder approach to explore how digital technology can support the cocreation of value between patients and their care teams in the delivery of total knee replacement (TKR) surgery, an increasingly common procedure to return mobility and relieve pain for people suffering from osteoarthritis.ObjectiveThe aim of this study was to investigate communications and interactions between patients and care teams in the delivery of TKR to identify opportunities for digital technology to add value to TKR health care service by enhancing the cocreation of value.MethodsA multistakeholder qualitative study of user needs was conducted with Australian stakeholders (N=34): surgeons (n=12), physiotherapists (n=3), patients (n=11), and general practitioners (n=8). Data from focus groups and interviews were recorded, transcribed, and analyzed using thematic analysis.ResultsEncounters between patients and their care teams are information-rich but time-poor. Results showed seven different stages of the TKR journey that starts with referral to a surgeon and ends with a postoperative review at 12 months. Each stage of the journey has different information and communication challenges that can be enhanced by digital technology. Opportunities for digital technology include improved waiting list management, supporting and reinforcing patient retention and recall of information, motivating and supporting rehabilitation, improving patient preparation for hospital stay, and reducing risks and anxiety associated with postoperative wound care.ConclusionsDigital technology can add value to patients’ care team communications by enhancing information flow, assisting patient recall and retention of information, improving accessibility and portability of information, tailoring information to individual needs, and by providing patients with tools to engage in their own health care management. For care teams, digital technology can add value through early detection of postoperative complications, proactive surveillance of health data for postoperative patients and patients on waiting lists, higher compliance with rehabilitation programs, and reduced length of stay. Digital technology has the potential to improve patient satisfaction and outcomes, as well as potentially reduce hospital length of stay and the burden of disease associated with postoperative morbidity.

Improving patient outcomes following total joint arthroplasty: is there an app for that?

“…Through a qualitative study of user needs related to TKA, van Kasteren et al showed that information and communication needs indeed change throughout the TKA 'journey', concluding that opportunities to leverage technological solutions are therefore dependent on both the patient's stage of recovery as well as the specific goal of the intervention. 29 Indeed, the need for clinicians to deliver the 'right information at the right time' was a key finding of the study by van Kasteren et al, which also concluded that digital technology could facilitate improved communication from patients to clinicians. 29 In summary, users of technology to promote patient activation must recognise the need to actively integrate patients into the healthcare team as well as to inspire them to take control of their own care.…”

“…29 Indeed, the need for clinicians to deliver the 'right information at the right time' was a key finding of the study by van Kasteren et al, which also concluded that digital technology could facilitate improved communication from patients to clinicians. 29 In summary, users of technology to promote patient activation must recognise the need to actively integrate patients into the healthcare team as well as to inspire them to take control of their own care.…”

“…As the study by van Kasteren et al showed, interventions that are found to be successful for inpatients may be quite different from those that have utility for patients who are either preparing for or recovering from surgery at home. 29 Additional research is needed to determine the key interventions required to successfully increase patient activation at each stage in a patient's journey, beginning with the decision to undergo surgery and ending once maximal recovery has been achieved. Educational interventions may be more important prior to surgery while daily reminders, symptom tracking and automated triggers resulting in contact with a member of the care team may be most helpful in the early postoperative period.…”

Total Knee Replacement: Subject-Specific Modeling, Finite Element Analysis, and Evaluation of Dynamic Activities

“…Osteoarthritis is a degenerative disease that affects millions of people every year and has unprecedented consequences on their quality of life. Total knee replacement (TKR) or total knee arthroplasty (TKA) is mainly used as a surgical treatment of osteoarthritis since it relieves pain, improves mobility (Woolhead et al, 2005;van Kasteren et al, 2018), and is a common practice usually among female patients at the age of 65 (Woolhead et al, 2005;Kim et al, 2014;Lum et al, 2018;van Kasteren et al, 2018). However, pain and immobility issues insist on a 10-34% of TKR patients (van Kasteren et al, 2018) caused by implant failure.…”

Effect of Remote Monitoring on Discharge to Home, Return to Activity, and Rehospitalization After Hip and Knee Arthroplasty

“…[7][8][9][10] Remote monitoring technologies such as activity monitoring and text messaging may help facilitate support for patients outside of traditional clinical settings, and could be used to help clinicians improve outcomes for this population in a scalable way. [11][12][13][14] There is also an opportunity to integrate monitoring programs with the electronic health record, to ensure that this support occurs within the workflow and does not overburden clinicians.…”