Remote monitoring program may reduce rehospitalization rate after TJA

Evan M. Schwechter, MD

Though the authors’ main outcome measure in this randomized trial was examining the rate of discharge to home after total joint replacement, the more interesting outcome measure was the rehospitalization rate for those who received remote monitoring vs. those who did not. Perhaps not unsurprisingly, a significantly decreased rehospitalization rate was found in those patients who received remote monitoring with feedback. Additional intervention beyond simple remote monitoring with feedback was not found to be any more helpful. 

These results simply underscore the importance of “touch points” in the postoperative care pathway. The easier, and the more frequent, the contact is between patient and provider, the more likely postoperative concerns will be addressed expeditiously by the right provider and the less likely a rehospitalization will occur. Technology, in any form, whether it is a remote monitoring system, televideo or simply telephone calls will likely produce this outcome. 

As remote monitoring failed to increase the rate at which patients were discharged to home, it is clear that this outcome is a complex issue in which numerous variables exist. Socioeconomic status, living situation, family support, presurgical mobility and preconceived concerns regarding discharge home are just some of the issues. Perhaps future technology will be able to address some of these.

Jeremy M. Gililland, MD

This is an important study evaluating the impact of remote monitoring on primary TJA patients. These primary TJA patients were deemed intermediate risk for discharge to home by the risk assessment and prediction tool (RAPT) and were randomized to either usual postoperative care or remote monitoring. The primary outcome was discharge status (home vs. skilled facility), with secondary outcomes including change in average daily step count and rehospitalizations.

While the remote monitoring program did not impact the discharge disposition or change in step counts in these patients, it did show a significant reduction in rehospitalizations, which may have resulted from goal setting and connection to the care team. The fact that remote monitoring did not impact discharge disposition in this population is not all that surprising as these patients were deemed intermediate risk for home discharge by the RAPT score. However, this remote monitoring tool did show an almost a fourfold reduction in hospital readmissions, and this finding is important.

As more TJA patients are being discharged home on an outpatient basis, tools that promote postoperative connection to the care team are extremely important and warrant further investigation. Seventy-one percent of remote monitoring participants in this study felt that “the program made them feel more connected to the care team,” which may be one of the most important impacts of any remote monitoring tool.