Telehealth Study Touts Benefits of RPM for Joint Replacement Rehabilitation

A telehealth platform that includes mHealth wearables and a text messaging platform helped healthcare providers at Penn Medicine reduce rehospitalizations by 75 percent among patients who’d had hip or knee replacements.

Researchers with the health system, posting the study this week in JAMA Network Open, say the remote patient monitoring program can help health systems improve clinical outcomes while saving hundreds of thousands of dollars in medical costs.

“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,” Shivan Mehta, MD, associate chief innovation officer at Penn Medicine and the study’s lead author, said 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.”

The study adds to the growing library of evidence that RPM programs can improve outcomes and reduce unnecessary costs, while pushing care management from the hospital, clinic or doctor’s office into the home. Providers across the country are using a variety of telemedicine and mHealth tools, including apps, smart devices, audio-visual communications and even mHealth games, to improve care management and reduce the burden on hospitals.

It also comes at a time when many hospitals are dealing with a surge in patients due to the coronavirus pandemic and are looking for ways to move more care to the home and reduce chances of infection for both patients and providers.

From February 2018 to April 2019, Mehta and his team tracked 242 patients in the clinical trial, splitting them up into two groups. One group received the standard pattern of post-discharge care, while the other group was enrolled in Penn Medicine’s HomeConnect+ program, a so-called “hovering” platform that uses wearable devices and conversational text messaging to check in with patients at home and monitor their daily activity and pain levels.

According to researchers, only 3 percent of those using the connected care platform returned to the hospital within 45 days of their surgery to deal with complications, while 12 percent of those in standard care made the return trip.

Mehta and his colleagues say the text messaging platform, which included daily reinforcement and content on milestones and medication management as well as feedback, likely helped reduce rehospitalizations by giving patients an easy alternative – a dedicated call line - to calling their primary care provider or going to the local ER when they had an issue.

In addition, they found no difference between the two groups in the rate of physical activity during rehab or the percentage of discharges to the home, rather than a rehabilitation or skilled nursing facility, an indication that the telehealth platform is on a par with in-person care for outcomes.

Mehta and his colleagues noted the virtual care program did boost patient engagement, and said it could probably improve activity levels if it was deployed for a longer period of time.

“Hospital readmission is a metric of low quality care and recovery and high cost for patients and health care providers,” Eric Hume, MD, an associate clinical professor of Orthopaedic Surgery, director of Quality and Safety in Orthopaedic Surgery at Penn Medicine and a co-author of the study, said in the press release. “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.”

The study was supported by a grant from the National Institutes of Health’s National Cancer Institute and involved researchers from the University of Pennsylvania, the Penn Medicine Center for Health Care Innovation, the NYU Grossman School of Medicine and the Philadelphia VA Medical Center’s Center for Health Equity Research and Promotion.