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Simplifying Recovery from Total Joint Replacement with Digital Care

May 2, 2022
Posted in Population Health

Article Summary


After receiving consistent feedback from patients that they had inadequate expectations for recovery after joint surgeries, Providence’s Southern California region utilized a digital platform to automate patient support—ensuring patients understood the recovery process, what to anticipate regarding pain after joint surgeries, and how to manage it.

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Featured Outcomes
  • 44 percent decrease in hospital readmissions.
  • 15 percent decrease in length of stay.
  • 92 percent of patients found Twistle helpful.*
  • Eight percent increase in patients discharged to home (vs. SNF).

* Based on a patient satisfaction survey deployed by Twistle at the conclusion of the treatment pathway

CLINICAL PRIORITY

After receiving consistent feedback from patients that they had inadequate expectations for recovery after joint surgeries, Providence’s Southern California region initiated an education program. The purpose was to ensure patients understood the recovery process, what to anticipate regarding pain after joint surgeries, and how to manage it. They also wanted to reduce length of stay as well as 30-day readmissions to improve performance in their value-based bundled payment model.

After initiating an in-person patient education program, they saw good improvements both for the patient experience as well as post-operative recovery metrics, but the initiative was labor intensive and inefficient for staff to manage.

Providence then evaluated digital platforms that could automate patient support throughout the joint replacement experience.

APPROACH

Providence collaborated with Twistle by Health Catalyst to build digital care plans for total hip replacement (THR) and total knee replacement (TKR) surgeries. These care plans were designed to automatically deliver the right information to patients at the right time including education, reminders, surveys, checklists, and messages from their care team. The Total Joint Replacement Pathway supports:

  • Pre-operative preparation
  • Day of surgery guidance
  • Post-operative recovery at home

Patients receive information about how to prepare for surgery, including a video of their surgeon delivering a message of reassurance and comfort. Messages after the procedure provide step-by-step guidance to help patients adhere to their care plan. These timely check-ins also give providers assurance that the patient will be supported at home and can avoid being discharged to a skilled nursing facility.

“Loved receiving these text messages. They answered a lot of the questions I had written down for the doctor.”


“I liked being able to get timely reminders, ask questions, and communicate about how healing is going.”

Patients Enrolled in Twistle, Satisfaction Survey

PILOT APPROACH

A cohort of patients undergoing a THR or TKR were invited to use Twistle and 83% of those invited adopted the program. Approximately two-thirds of the patients received a TKR and one-third a THR.
The study compared outcome and cost data for 388 patients who used Twistle, with 751 patients who did not use Twistle.

“This pilot was so successful in improving the patient experience and performance in our bundled payment models, we are expanding the Twistle pathways throughout Southern California.”

Tom Burton, PT, Director of Operations Orthopedic and Neuroscience Clinical Institutes, Providence

RESULTS*

  • The Twistle cohort experienced a 44% reduction in hospital readmissions and a reduction in surgical complications
  • Length of stay was reduced by 15%
    • Patients were better prepared to recover at home
    • Physicians felt reassured that patients could be closely monitored at home and have easy access to the care team via Twistle
  • The number of inpatients being discharged after one day doubled to around 40%, and those staying more than two days was rare
  • The number of patients discharged to a skilled nursing facility (SNF) also decreased as a result of closer in-home monitoring, which reduced the overall cost of care
  • Patient satisfaction and online ratings improved, as 92% found Twistle helpful and 80% would recommend Twistle
  • The platform increased the amount of patient-reported outcomes collection

* Based on analysis conducted in 2020 by the Orthopedic and Neuroscience Clinical Institutes and 2020 data on patient engagement provided by Twistle

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