This document describes a study that validated the use of an m-Health system for monitoring postoperative patients from ambulatory surgery units. The study involved 310 patients split into a pilot group that used the m-Health system and a control group without it. The study aimed to evaluate clinical indicators and patient outcomes. The results showed no significant differences between the groups in pain levels, complications, or calls/visits to the hospital. The m-Health system did not negatively impact postoperative care or decrease quality of care compared to standard phone follow-ups.

1. 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

2. 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
Session 9f: eHealth, 29 October 2010 eChallenges e-2010 Copyright 2010 ITACA-TSB

3. 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
Session 9f: eHealth, 29 October 2010 eChallenges e-2010 Copyright 2010 ITACA-TSB

4. 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
Session 9f: eHealth, 29 October 2010 eChallenges e-2010 Copyright 2010 ITACA-TSB

5. 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
Session 9f: eHealth, 29 October 2010 eChallenges e-2010 Copyright 2010 ITACA-TSB

6. 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
Session 9f: eHealth, 29 October 2010 eChallenges e-2010 Copyright 2010 ITACA-TSB

7. 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)*
Session 9f: eHealth, 29 October 2010 eChallenges e-2010 Copyright 2010 ITACA-TSB

8. Methodology: Sample size and pathologies
Session 9f: eHealth, 29 October 2010 eChallenges e-2010 Copyright 2010 ITACA-TSB

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

10. Methodology: m-Health System
GPRS/UMTS
Session 9f: eHealth, 29 October 2010 eChallenges e-2010 Copyright 2010 ITACA-TSB

11. 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
Session 9f: eHealth, 29 October 2010 eChallenges e-2010 Copyright 2010 ITACA-TSB

12. 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
Session 9f: eHealth, 29 October 2010 eChallenges e-2010 Copyright 2010 ITACA-TSB

13. Major outcomes and their significance
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
Session 9f: eHealth, 29 October 2010 eChallenges e-2010 Copyright 2010 ITACA-TSB

14. Major outcomes and their significance
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
Session 9f: eHealth, 29 October 2010 eChallenges e-2010 Copyright 2010 ITACA-TSB

15. 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
Session 9f: eHealth, 29 October 2010 eChallenges e-2010 Copyright 2010 ITACA-TSB

16. 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
Session 9f: eHealth, 29 October 2010 eChallenges e-2010 Copyright 2010 ITACA-TSB

17. Mobile photos sent by the patients of the Pilot group
Session 9f: eHealth, 29 October 2010 eChallenges e-2010 Copyright 2010 ITACA-TSB

18. Mobile photos sent by the patients of the Pilot group
Session 9f: eHealth, 29 October 2010 eChallenges e-2010 Copyright 2010 ITACA-TSB

19. 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