Telehealth may increase office efficiency, access to care for revision TJA
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Key takeaways:
- Telehealth may improve office efficiency and reduce barriers to care for patients evaluated for revision joint arthroplasty.
- It may also offer technological convenience and reduce travel burdens for patients.
Use of telehealth for patients who require revision total joint arthroplasty may improve office efficiency and reduce barriers to care, according to published results.
Rex W. Lutz, DO, orthopedic surgery resident at Jefferson Health in New Jersey, and colleagues performed a retrospective analysis of data for 381 consecutive patients who were evaluated for revision TJA by two surgeons from a single academic institution.
According to the study, Lutz and colleagues assessed the feasibility of evaluating patients with telehealth to improve office efficiency and patient access. Efficiency was defined by the percentage of patients who were “adequately evaluated” with telehealth. They also assessed the diagnostic capabilities of telehealth after review of patients who were ultimately indicated for revision.
“Telehealth appears to be not just a technological convenience but also a viable option for improved office efficiency and patient access,” Lutz and colleagues wrote in the study.
Among 229 patients evaluated for revision total knee arthroplasty, 99 patients (43.2%) were indicated for revision, with 63 patients (63.6%) ultimately undergoing revision TKA. Lutz and colleagues found 53.5% (n = 53) of the 99 patients indicated for revision TKA could have been evaluated and indicated for surgery with telehealth. They noted the remaining 46 patients were indicated for revision secondary to instability, which required an in-office examination. Lutz and colleagues concluded the overall efficiency of telehealth for patients evaluated for revision TKA was 79.9%.
Among 152 patients evaluated for revision total hip arthroplasty, 55 patients (36.2%) were indicated for revision, with 43 patients (78.2%) ultimately undergoing revision THA. Lutz and colleagues found all of the 55 patients indicated for revision for THA could have been evaluated and indicated for surgery with telehealth.
Lutz and colleagues found patients indicated for revision TKA traveled an average of 32.4 miles and a maximum of 257 miles, while patients indicated for revision THA traveled an average of 26.2 miles and a maximum of 107 miles.
“Beyond the logistical advantages, this method presents a promising solution to alleviate the often-extensive travel burdens faced by revision TJA patients,” Lutz and colleagues concluded.
Perspective
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As provider reimbursement decreases and access to care becomes more of an issue, we are seeing the development of several patterns in joint replacement surgery: specialization and regionalization of care. Patient wait times are increasing, and patients are having difficulty finding providers, especially for complex or revision cases.
In this era of increasing pressures on health systems and providers, technology to help improve patient access and provider efficiency while maintaining quality of care is increasingly important, especially when considering the value equation of quality and cost. The adoption of telemedicine is one of those solutions. Patients are more used to doing “Zoom calls” and leveraging technology in their everyday lives. The findings by Rex W. Lutz, DO, and colleagues specifically examine how telemedicine can help patients in a revision joint replacement situation: 100% of the revision hip replacement cases and 79.9% of revision knee replacement cases could be diagnosed and triaged/managed via telemedicine.
It is my feeling that this method can be safe and effective at providing care in these difficult situations without compromising quality. An important next step would be to study the outcomes of these patients after their revision surgery.
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