An Integrated Model of Intelligent Medical Service for Total Joint Replacement
Condition: Health Knowledge, Attitudes, Practice
Study type: Interventional

Summary: 
      With the aging population, the needs for total joint replacement are increasing. A successful
      recovery after joint replacement surgery depends on timely and active physical therapy in the
      early postoperative period. To accomplish it, an integrated care model based on clinical
      pathway has been implemented to secure the medical quality and patient safety. Recently, the
      emerging technology of electronic medical record and medical informatics have made challenges
      to the traditional health care models such as the clinical pathway. As a matter of fact, the
      integration of informatics technology also provides an opportunity to modernize the clinical
      pathway and make it smarter. By bridging the HIS system and the medical cloud of a virtual
      platform of interactive clinical pathway, the quality of care and patient safety can be
      better secured and the performance can be stored for analysis.

      The project " The effects of intelligent clinical pathway for total joint replacement" is a
      subproject of the integrated project " An integrated model of intelligent medical service for
      total joint replacement". It will be carried out in a facility built with intelligent
      environment (Kaohsiung CGMH) and the data will be stored and computed in the medical care
      cloud and specialist system server. Collaborating with subproject 2 and 4 (smart wearing
      device) and subproject 3 (total nursing care), this project is intended to set the milestones
      for the postoperative recovery after total joint replacement. Supplemented with the
      specialist system and interactive programs, it will be implemented in total joint replacement
      patients as an vehicle for perioperative assessment, follow-up, monitoring, and instruction.
      The big data of the objective analytic results and feedback from the patients will be the
      important reference for medical and health promotion.
    

Detailed description: 
      With the aging population, the needs for total joint replacement are increasing. On the basis
      of 2000-to-2014 data from National Inpatient Sample (NIS), primary total knee arthroplasty
      (TKA) is projected to grow by 85% to 1.26 million procedures in the United States by 2030. In
      a 2012 report of Orthopaedic Industry, and the global sales of joint replacement products
      exceeded $49.3 billion, with knees taking about half of them. The high financial burden of
      joint replacement surgery on health care system highlights the importance of cost containment
      without compromising the quality of patient care.

      Clinical pathways for total joint arthroplasty can reduce care variability and improve the
      quality of care. Taiwan's Bureau of National Health Insurance (BNHI) has initiated a
      prospective payment system for TKA under diagnosis-related group (DRG) since 1997. It was
      found the length of hospital stay, and the medical expenditure could be reduced because
      standard clinical pathways were implemented in most hospitals. However, to optimize the
      results and meet with patients' expectation are more challenging currently than before
      because the length of hospitalization is markedly reduced and the standard care processes are
      accelerated. The accelerated programs for total joint arthroplasty are revolutionizing the
      standard clinical pathways. Patients can even be discharged from the hospital within one day
      after the surgery. While a successful joint replacement surgery depends on well-practiced
      clinical pathways delivered in a timely manner, patient's medical literacy should also have a
      significant impact for his or her recovery. Unfortunately, patients may acquire incorrect
      information from the internet or have unrealistic expectations before or during the
      hospitalization that may compromise the decision making and clinical results.

      Recently, the emerging technologies of the electronic medical record and medical informatics
      have made challenges to the traditional healthcare models such as the clinical pathways. The
      integration of informatics technology also provides an opportunity to modernize the clinical
      pathways. But the effect of an interactive infotainment system on TKA is unknown. The purpose
      of this study was to analyze whether the implementation of an interactive infotainment system
      into a standard clinical pathway of TKA could influence the hospital course and the medical
      quality in an arthroplasty specialty ward.
    

Intervention name(s): Patient infotainment system
Intervention type(s): Device
Intervention description(s): The patient infotainment system is a quasi-interactive computer program connected to a server that pushes messages and educational programs ordered from the caring physicians or on-demand by the patients. The server has parallel data exchange gateways to the Hospital Information System (HIS), Picture Archiving Communication System (PACS), and can record the patients' responses to surveys and questionnaires.
Allocation: Non-Randomized
Intervention model: Parallel Assignment
Masking: Single (Outcomes Assessor)
Primary purpose: Health Services Research