Validation of an m-Health Solution for the Follow-Up of Post-operative Patients of Ambulatory Surgery

Validation of an m-Health Solution for the Follow-Up of
p
Post-operative Patients of Ambulatory Surgery

María-José Nodal
ITACA-TSB
Spain
manodal@itaca.upv.es

Session 9f: eHealth, 29 October 2010 eChallenges e-2010 Copyright 2010 ITACA-TSB

Problem area

Nowadays more complex operations and high risk patients are being
included in ambulatory surgery programs

Ambulatory Surgery Units manage home post-operative processes that
demand higher care and more intensive monitoring than usual

It’s necessary to improve the communication between the Ambulatory
Surgery Unit and the patients at home

The motivation is to offer healthcare quality at home comparable to
hospital care without its drawbacks


Motivation

Preliminary study
Pilot Group (with m-Health System): Control Group (without m-Health System):
61 patients 61 patients

Results of the preliminary study
Increase of patient Decrease of costs related to
Increase of clinical indicators
satisfaction post- operative health care

Second study
y
Pilot Group (with m-Health System): Control Group (without m-Health System):
156 patients 154 patients


Research Objectives

Main objecti e in the study
objective st d

• To validate the impact of the use of an m-Health system for the
m Health
follow-up of post-operative patients of ambulatory surgery

Objective in the second study

• To corroborate and validate the results of the preliminary study
with more patients and during a longer period of time


Research approach, Methodology

Design f
D i of Sample size
S l i Analysis
A l i
Clinical Data
the sample and of the
indicators collection
group pathologies results


Methodology: Design of the sample group

Control Group
p Pilot Group
p

• Patients from the • Patients from the
Ambulatory Surgery Unit Ambulatory Surgery Unit
y g y
• Patient with any of the • Patient with any of the
pathologies chosen for the pathologies chosen for the
study study
• Usual phone control protocol • Usual phone control protocol
at home (*SCORE) at home (*SCORE)
• Patients with m-Health
system at home

*SCORE: A usual phone control protocol that has been used regularly in the
Ambulatory Surgery Unit of the University Hospital Dr. Peset


Methodology: Design of the sample group

Both groups are similar in relation to:

• Th selection protocol
The l ti t l
• The anesthetic procedure
• Th surgical procedure
The i l d
• The analgesic protocol
• The healthcare protocol at home (SCORE)*


Methodology: Sample size and pathologies


Methodology: Sample

Sample g p
p group
Number of patients 310
40% Male 60% Female

Age range
g g
Under 25 Older than
years of 65 years of
25-35 36-45 46-55 56-65
age age


Methodology: m-Health System

GPRS/UMTS


Methodology: Clinical indicators

Clinical indicators

• Evaluation f h
E l i of the patient status by the S
i b h Score of the U i
f h Unit
• Patient calls to the hospital
• Number of visits to emergency
g y
• Readmissions
• Reoperations
• Changes in the post operative process
Ch i th t ti
• Staff time used to evaluate the patients progress by phone


Major outcomes and their significance

Evaluation of the patient status by the Score of the Unit

• N clinical diff
No li i l differences b
between the groups regarding to: pain, status, oral
h di i l
tolerance or bleeding

Patient calls to the hospital

• Patient who called to the hospital were only the 9% of the total of the both
groups of the study
• No significant differences between the g p
g groups
• The pilot group did not show an increase in the number of calls



Number of visits to emergency, readmissions and reoperations

• Patient who visited emergency were only the 3.2 % of the total of the both
groups of the study
• The mobile telephone did not decrease significantly the visits to emergency
• In the study three readmissions have been observed (1%)
• The variable “to use mobile phone” has not represented any significant
difference in readmissions
diff i d i i
• No reoperation has been registered in none of the 310 patients of the study
after a month of evolution



Changes in the post operative process
• The pilot group showed one modification on the postoperative evolution (0.7%
of the patients with mobile phone)

Staff time used to evaluate the patients progress by phone
• The Pilot Group showed a 44.4% of higher work load in the calls to the patients
in comparison to the Control Group
p p
• Due to the patient have to send the photos and the nurse have to evaluate the
images


Conclusions

The protocol based on m-Health system does not seem to improve
the t di d li i l
th studied clinical quality i di t
lit indicators

Control time necessary for the evaluation of the images sent
through the mobile phone is 44 4% higher increasing the
44.4% higher,
dedication time of the phone control staff without clear counterparts


Future lines of research

The technological solution has been transferred to the
company TSB S.A., spin-off of the University

TSB S.A. is currently exploring the exploitation viability in
y p g p y
ambulatory surgery, dermatology and plastic surgery

Future lines of research are focused in the development of on
line questionnaires via web and automated questionnaires
with voice recognition
ith i iti


Mobile photos sent by the patients of the Pilot group


Validation of an m-Health Solution for the Follow-Up of Post-operative Patients of Ambulatory Surgery

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