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CC BY 4.0 · ACI open 2022; 06(01): e11-e20
DOI: 10.1055/s-0042-1754011
Research Article

Design and Integration of Mobile Health Technology in the Treatment of Orthopaedic Surgery: A Qualitative Study

Courtenay R. Bruce
1   System Patient Experience, Houston Methodist Hospital System, Houston, Texas, United States
,
Patricia Harrison
1   System Patient Experience, Houston Methodist Hospital System, Houston, Texas, United States
,
Thomas M. Vinh
2   Information Technology Division, Houston Methodist Hospital System, Houston, Texas, United States
,
Agnita G. Manoharan
2   Information Technology Division, Houston Methodist Hospital System, Houston, Texas, United States
,
Charlie Giammattei
3   MedTrak, Inc., Philadelphia, Pennsylvania, United States
,
Caitlin Bliven
3   MedTrak, Inc., Philadelphia, Pennsylvania, United States
,
Jamie Shallcross
3   MedTrak, Inc., Philadelphia, Pennsylvania, United States
,
Aroub Khleif
2   Information Technology Division, Houston Methodist Hospital System, Houston, Texas, United States
,
Nhan Tran
2   Information Technology Division, Houston Methodist Hospital System, Houston, Texas, United States
,
Josh Sol
4   Center for Innovation, Houston Methodist Hospital, Houston, Texas, United States
,
Kayla Gutierrez
5   Department of Orthopedics, Houston Methodist Hospital System, Houston, Texas, United States
,
Bita A. Kash
6   Center for Outcomes Research, Houston Methodist Research Institute, Houston, Texas, United States
,
R. Benjamin Saldana
7   Department of Emergency Medicine, Houston Methodist Hospital, Houston, Texas, United States
,
Kwan J. Park
8   Department of Surgery, Houston Methodist Hospital, Houston, Texas, United States
,
Feibi Zheng
8   Department of Surgery, Houston Methodist Hospital, Houston, Texas, United States
,
Shetal-Nicholas Shetal Desai
4   Center for Innovation, Houston Methodist Hospital, Houston, Texas, United States
8   Department of Surgery, Houston Methodist Hospital, Houston, Texas, United States
,
Stephen L. Jones
5   Department of Orthopedics, Houston Methodist Hospital System, Houston, Texas, United States
8   Department of Surgery, Houston Methodist Hospital, Houston, Texas, United States
,
Barach P.
9   Jefferson College of Population Health, Pennsylvania, United States
10   Interdisciplinary Research Institute for Health Law and Science, Sigmund Freud University, Wien, Austria
,
Roberta Schwartz
6   Center for Outcomes Research, Houston Methodist Research Institute, Houston, Texas, United States
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Abstract

Background The use of mobile health (mHealth) technologies has dramatically increased in the past year. A critical component in the discussion about telehealth and mHealth technologies is the importance of integrating the voices of patients, caregivers, and their clinicians.

Methods This study was performed at a tertiary center in Houston consisting of 7 hospitals (1 academic and 6 community hospitals). The clinically integrated mHealth technology consisted of a mHealth education and monitoring platform that used patient-centered emails and text messages over a 50-day period, from prior to the orthopaedic total joint replacement surgery to posthospital discharge to provide education and health monitoring at home. Study participants included patients who were scheduled for total joint replacement surgery between July 2018 and November 2019, and their caregivers. The study involved two components: (1) focus group study (n = 15); split into two groups of participants who had not used the mHealth technology (α-testing during the design phase, prior to implementation); and (2) a content analysis of 377 free-text comments from patients who used the mHealth technology, and who responded to questions about their use of the mHealth platform (β-testing; after implementation, during the execution phase). Thematic analyses methods were used.

Results Three key themes emerged during the design phase including: (1) monitoring, bidirectional questions asking patients to respond to a question can feel invasive and/or annoying unless framed in a reciprocal, contextual-based way; (2) text messages should be used selectively for time-sensitive, critical information; and (3) information should be contained within the body of the message. Three themes emerged during the execution phase include: (1) the content should be divided into small, digestible chunks at the times that patients need that information; (2) the tone of the messages should be approachable and friendly, as opposed to detached and professional; and (3) mHealth technologies make patients calmer and more confident and less inclined to draw on hospital personnel, enabling patients to be managed by the automated program without escalating to human care. Limited, bidirectional engagement can foster interactivity and patient monitoring without becoming excessive or burdensome to health care professionals.

Conclusion The use of mHealth for patient care is likely to be more effective and used in this multihospital mHealth technology study of patients undergoing orthopaedic surgery, if they are clinically integrated with staff who can respond to escalated problems as needed, to enable better adoption, uptake, and sustainability of technology.

Keywords

mHealth technology - mHealth interventions - patient-facing technologies - patient-centered care - patient experience - patient engagement - patient activation - effectiveness - quality improvement - patient safety

Protection of Human and Animal Subjects

The study was performed in compliance with the World Medical Association Declaration of Helsinki on Ethical Principles for Medical Research Involving Human Subjects and was reviewed by the hospital's Institutional Review Board.




Publication History

Received: 19 October 2020

Accepted: 31 October 2021

Article published online:
01 July 2022

© 2022. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

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