The Addition of a Mobile App Technology to a Post-Discharge Home Care Program Following Thoracic Surgery Reduces the Rate of Emergency Room Visits
Yaron Shargall, Kristen Hughes, Patrice Pinkney, Jenelle Taylor, Yessica Lopez-Hernandez, Michal Coret, John Agzarian, Christian Finley, Anna Tran, Wael Hanna
McMaster University, St. Joseph's Healthcare, Hamilton, ON, Canada
Objective: Post-discharge readmissions and Emergency Room (ER) visits continue to be a major problem after thoracic surgery. Web-based mobile applications have been shown to reduce follow-up clinics' visits after breast surgery, but their role remains unexplored in thoracic surgery. We hypothesized that the addition of a patients' used, newly developed, thoracic-surgery specific mobile app for early diagnosis and communication with the home-care program team and surgeons will reduce ER visits and readmissions when compared to the home-care program alone.Methods: A retrospective review of a prospective database of patients undergoing major lung resection between 11.2016 and 10.2017 was performed. Patients were divided into two cohorts: a control group of home-care alone (No App) and an intervention group of home-care + App used by the patient post-discharge (App). Data was collected on demographics, perioperative factors, and post-discharge variables. Quality of life was evaluated with the Quality of Revovery-9 (QoR-9) and Generalized Anxiety Disorder-7 (GAD-7) scales. Student t-test was used to compare continuous variables, chi-square for categorical variables, and Wilocoxon Rank-Sum for non-parametric variables. Multivariate Logistic regression was used to determine independent predictors for ER visits. The cutoff for statistical significance was p<0.05.
Results: Of 346 patients, 247 were in the No App cohort and 99 were in the App cohort. There were no differences in baseline demographics and comorbidities (Table 1). Patients in the App cohort had a higher incidence of lobar resections (78.8% vs 63.2%, p=0.005), and thoracotomy (36.4% vs 24.3%, p=0.023). While 30-days readmission rates were similar between the App and No App cohorts (6.1%, p=NS), patients using the mobile app were less likely to be seen in ER than the control group (15.15% vs 27.94%%, p=0.012). Multivariate logistic regression identified that App usage is the only independent predictor for reduction of ER visits (OR= 0.47, p=0.018). A subset of patients (39% in the App and 36% in the No App, p=0.56) were contacted to complete the QoR-9 and GAD-7 surveys. There was no difference in the proportion of patients with a GAD-7 score = 0, which indicates absence of post-discharge anxiety and depression symptoms, between cohorts (79.78% No App vs 79.49% App, p=NS).
Conclusions: The addition of a mobile App to a post-discharge home-care program significantly reduced the frequency of ER visits after thoracic surgery in spite of higher proportions of thoracotomies and anatomical resection in the App cohort. A longitudinal comparative study is needed to determine the full effect of this emerging technology on healthcare outcomes and cost reduction.
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