Feasibility of a web-based and mobile supported follow-up treatment pathway for adult orthopedic trauma patients in the Netherlands: a concurrent mixed-method study (Preprint)
Authors: Willinge Gijs , Spierings Jelle , Romijnders Kim , Mathijssen Elke , Twigt Bas , Goslings Carel , van Veen Ruben 
Published: March 2024

BACKGROUND

Orthopedic trauma care encounters challenges in follow-up treatment due to varying and often limited patient information provision, treatment variation, and the chaotic setting in which it is provided. Additionally, the pressure on healthcare resources is rising globally. To address these issues, digital follow-up treatment pathways were implemented for orthopedic trauma patients, aiming to optimize healthcare resource utilization and enhance patient experiences.

OBJECTIVE

To assess the feasibility of digital follow-up treatment pathways from the patient's perspective and their impact on healthcare resource utilization.

METHODS

A concurrent mixed-method study was conducted parallel to the implementation of the digital follow-up treatment pathways in an urban level-2 trauma center and teaching hospital between October 1, 2022 – April 1, 2023. Inclusion criteria were: 1) minimum age of 18 years, 2) active account for the study institution’s web-based patient portal ; 3) able to read and write in Dutch; and 4) no cognitive impairment or pre-existing motor impairment. Data were collected via electronic patient records and surveys at three time points: T0: within three days of the ED visit, T1: 4-6 weeks post-injury and T2: 10-12 weeks post-injury. Semi-structured interviews were performed at 10-12 weeks post-injury. Quantitative data were reported descriptively and the digital treatment pathway group was compared to a similar control group using anonymous data from a pre-existing institutional database to compare for healthcare resource utilization. A thematic analysis was used for qualitative data. All outcomes were categorized according to the Bowen feasibility parameters: acceptability, demand, implementation, integration, and limited effcacy.

RESULTS

In total, 66 patients were included for quantitative data collection. Survey response rates were 100% at T0, 92% at T1, and 79% at T2. Respondent groups per time point did not significantly differ from one another. For qualitative data collection, 15 semi-structured interviews were performed. Patients reported a median satisfaction score of 7 (IQR:6-8) with the digital treatment pathway and an 8 (IQR 7-9) for overall treatment, reflecting positive experiences regarding the functionality, actual and intended use, and safety of treatment. The digital treatment pathways reduced secondary healthcare utilization, with fewer follow-up appointments by phone in digital treatment pathway patients (median 0, IQR: 0-0) vs. the control group (median 1, IQR: 0-1). Qualitative data highlighted positive experiences with functionalities, intended use and safety, but also identified areas for improvement, such as managing patient expectations, platform usability, and protocol adherence.

CONCLUSIONS

Utilization of digital follow-up treatment pathways is feasible, yielding satisfactory patient experiences and reduced healthcare resource utilization. Recommendations for improvement include early stakeholder involvement, integration of specialized digital tools within electronic health record systems, and hands-on training for involved healthcare professionals. These insights can guide clinicians and policymakers in effectively integrating similar digital tools into clinical practice

CLINICALTRIAL

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