Authors: Paraskevi Vivian Papas, BS; Seong Jin Kim, MPH; Sarah Ulcoq, MOT; Fred D. Cushner, MD, Giles R. Scuderi, MD
Abstract
Introduction
In recent years, online patient portals have been developed to offer the potential of an enhanced recovery experience. By offering targeted education, communication tools and patient-reported outcomes (PROs) collection, online portals encourage patients’ engagement in their own care. In the total joint arthroplasty (TJA) population, portals may also offer online physical therapy (PT), allowing TJA patients to reach functional goals while reducing costs. Although technology may potentially offer an enhanced recovery experience, disparities may exist in the comfort level of use of different patient populations. Our study aimed to analyze the utilization of an online patient portal, and quantify the impact of usage on PROs.
Methods
4,458 patients who underwent TJA across 8 major academic centers within one healthcare system were analyzed. Patients who scheduled surgery were registered for the online portal by the surgical coordinator. Upon registration, patients opt-in by signing an end-user license agreement (EULA), and data is collected on their utilization including logins, exercise and educational videos watched, messages sent and PROs completed. Age was compared to utilization, opt-in rates, total videos watched, and messages sent. Two separate patient cohorts were identified to distinguish between active and non-active users. Anyone who opted-in and viewed over 5 preoperative videos or had at least 5 preoperative logins were considered active users. Patients’ postoperative KOOS-JR and HOOS-JR score improvements from baseline were compared between the active vs. non-active groups.
Results
Of 4,458 total TJA patients, TKA and THA comprised 2670 and 1788, respectively, with an average age of 65.9 years (range 16-96 years). On average, patients logged into the portal 3.7 times preoperatively and 6.8 times postoperatively, and sent 2.29 messages. On average, 13 videos were watched preoperatively and 17 videos were watched postoperatively. Of all TJA patients, 72% opted-in to the portal. When looking solely at the TKA cohort, there was a significant difference in age between patients who had access to email (mean age 66.3) vs no access (mean age 69.7) (p=.001). There was no significant impact of age on total preoperative or postoperative logins when considering both TKA and THA patients. There was a significant difference between age and preoperative or postoperative logins in the TKA group, with older patients tending to log in less (p=.001) and send fewer messages to the Care Team (p=.0001).
Total videos watched pre- and post-operatively as well as preoperative logins did not impact change of HOOS JR scores at 6-weeks, 12-weeks, 6-months or 1-year. In the TKA cohort, active user group displayed significantly greater improvement in KOOS-JR scores at 6-weeks (p=.02), and 12-weeks (p=.018).
Conclusion
Although there was no association between age and portal engagement in the TJA population, significantly less engagement was seen in older patients in the TKA cohort. As the average age of a TKA patient continues to decrease, surgeons will be faced with a younger patient population that communicates heavily through technology. Additionally, previously published literature has proven online PT is as effective as traditional PT, making online portals a promising option to improve care while decreasing costs. As seen in our TKA population, patients experienced greater improvement in KOOS-Jr scores with greater engagement and use of the portal.