Feasibility of a Web-Based and Mobile-Supported Follow-Up Treatment Pathway for Adult Patients With Orthopedic Trauma in the Netherlands: Concurrent Mixed Methods Study
Authors: Willinge Gijs J A , Spierings Jelle F , Romijnders Kim A G J , Mathijssen Elke G E , Twigt Bas A , Goslings J Carel , van Veen Ruben N 
Published: September 2024

Abstract

Background
Orthopedic trauma care encounters challenges in follow-up treatment due to limited patient information provision, treatment variation, and the chaotic settings in which it is provided. Additionally, pressure on health care resources is rising worldwide. In response, digital follow-up treatment pathways were implemented for patients with orthopedic trauma, aiming to optimize health care resource use and enhance patient experiences.

Objective
We aim to assess digital follow-up treatment pathway feasibility from the patient’s perspective and its impact on health care resource use.

Methods
A concurrent mixed methods study was conducted parallel to implementation of digital follow-up treatment pathways in an urban level-2 trauma center. Inclusion criteria were (1) minimum age of 18 years, (2) an active web-based patient portal account, (3) ability to read and write in Dutch, and (4) no cognitive or preexisting motor impairment. Data were collected via electronic patient records, and surveys at three time points: day 1‐3, 4‐6 weeks, and 10‐12 weeks after an initial emergency department visit. Semistructured interviews were performed at 10‐12 weeks post injury. Anonymous data from a pre-existing database were used to compare health care resource use between the digital treatment pathways and traditional treatment. Quantitative data were reported descriptively. A thematic analysis was used for qualitative data. All outcomes were categorized according to the Bowen feasibility parameters: acceptability, demand, implementation, integration, and limited efficacy.

Results
Sixty-six patients were included for quantitative data collection. Survey response rates were 100% (66/66) at day 1‐3, 92% (61/66) at 4‐6 weeks, and 79% (52/66) at 10‐12 weeks. For qualitative data collection, 15 semistructured interviews were performed. Patients reported median satisfaction scores of 7 (IQR 6‐8) with digital treatment pathways and 8 (IQR 7‐9) for overall treatment, reflecting positive experiences regarding functionality, actual and intended use, and treatment safety. Digital treatment pathways reduced secondary health care use, with fewer follow-up appointments by phone (median 0, IQR 0‐0) versus the control group (median 1, IQR 0‐1; P<.001). Consequently, fewer physicians were involved in follow-up treatment for the intervention group (median 2, IQR 1‐2) than for the control group (median 2, IQR 1‐3; P<.001). Fewer radiographs were performed for the intervention group (median 1, IQR 0-1) than for the control group (P=.01). Qualitative data highlighted positive experiences with functionalities, intended use, and safety, but also identified areas for improvement, including managing patient expectations, platform usability, and protocol adherence.

Conclusions
Use of digital follow-up treatment pathways is feasible, yielding satisfactory patient experiences and reducing health care resource use. Recommendations for improvement include early stakeholder involvement, integration of specialized digital tools within electronic health record systems, and hands-on training for health care professionals. These insights can guide clinicians and policy makers in effectively integrating similar tools into clinical practice.