Authors: Seong Jin Kim, MPH1; Michael Suk MD JD MPH MBA2
1Clinical Integration & Research Division, Force Therapeutics, New York, NY
2Department of Orthopedics, Geisinger Medical Center, Danville, PA
Abstract
Introduction
Rural patient population presents a challenge for delivery of follow-up and continuity of care to hospitals and healthcare systems. There are 30 specialists per 100,000 residents in rural areas vs. 263 specialists per 100,000 residents in urban areas. Patients in rural communities are located farther away from their medical providers, resulting in longer travel and time off work. Expanding healthcare access to rural areas is not a cost- and time efficient solution as it requires up-front costs and long-term planning. Digital health is potential solution to combat the widening disparity in access to healthcare.
Objectives
The objective is to describe and evaluate the impact of patients’ geographic location on online patient engagement in rural orthopedic population.
Study Population
980 patients who underwent total joint arthroplasty (either total knee or hip arthroplasty) were included. Patients were operated by multiple surgeons across one health system (Geisinger Health, PA). Patients were enrolled in the online rehabilitation platform offering multi-format (text, image, video) communication and video-based post-surgical education (Force Therapeutics, NY). Patients provided their 5-digit home zip codes upon enrollment.
Methods
Patients were divided into 2 groups based on their geographical location from their hospitals (>=15km vs. <15km). Using the patient-reported zip codes, individual latitudes and longitudes were derived. Based on the coordinates, approximate distances were determined using the Haversine Formula, which calculates the great-circle distance between two points (shortest distance over the earth’s surface; “as-the-crow-flies”)
Results
On average, patients lived approximately 25-30km away from their assigned hospitals. We see a high concentration around the hospitals. (Figure 1). 410 patients lived 15km or more from their hospitals while 570 patients lived within the 15km radius. The baseline characteristics (Age, Body Mass Index) were not statistically different between the two groups. (Table 1). Remote patients had significantly higher number of logins (p<0.05), hourly sessions spent on the platform (p<0.05) and post-op video views (p<0.05) compared to those living closer (<15km) to their hospitals. (Table 1). Overall, patients residing 15km or more from their hospitals (“Remote patients”) showed higher levels of engagement.
Conclusion
Remote patients tend to be more inclined to use an online platform for their post-surgical care. This could indicate that online platform could be a viable solution to reducing disparity in access to healthcare. We should seek more ways to utilize digital help in addressing health equity for rural, underserved communities. Key is to sustain rural patients’ engagement via highly personalized interactions and content.
