An Integrated Model of Intelligent Medical Service for Total Joint Replacement

NCT03788798 | Completed

• 1 other identifier: 104-8598B
• Study Type: interventional
• Target: 86
• Locations: 1 country
• Sites: 1

Brief Summary

With the aging population, the needs for total joint replacement are increasing. A successful recovery after joint replacement surgery depends on timely and active physical therapy in the early postoperative period. To accomplish it, an integrated care model based on clinical pathway has been implemented to secure the medical quality and patient safety. Recently, the emerging technology of electronic medical record and medical informatics have made challenges to the traditional health care models such as the clinical pathway. As a matter of fact, the integration of informatics technology also provides an opportunity to modernize the clinical pathway and make it smarter. By bridging the HIS system and the medical cloud of a virtual platform of interactive clinical pathway, the quality of care and patient safety can be better secured and the performance can be stored for analysis. The project " The effects of intelligent clinical pathway for total joint replacement" is a subproject of the integrated project " An integrated model of intelligent medical service for total joint replacement". It will be carried out in a facility built with intelligent environment (Kaohsiung CGMH) and the data will be stored and computed in the medical care cloud and specialist system server. Collaborating with subproject 2 and 4 (smart wearing device) and subproject 3 (total nursing care), this project is intended to set the milestones for the postoperative recovery after total joint replacement. Supplemented with the specialist system and interactive programs, it will be implemented in total joint replacement patients as an vehicle for perioperative assessment, follow-up, monitoring, and instruction. The big data of the objective analytic results and feedback from the patients will be the important reference for medical and health promotion.

Conditions

Health Knowledge, Attitudes, Practice

Outcome Measures

Primary Outcomes (5)

• Length of stay

  in hospital stay (days)

  up to 10 days

• 30-day return to emergency room

  Patients who will return to the emergency room within 30 days after discharge

  within 30 days after discharge

• 30-day readmission after discharge

  Patients who will readmit within 30 days after discharge

  within 30 days after discharge

• 90-day return to emergency room

  Patients who will return to the emergency room within 90 days after discharge

  within 90 days after discharge

• 90-day readmission after discharge

  Patients who will readmit within 90 days after discharge

  within 90 days after discharge

Secondary Outcomes (1)

• medical expenditure

  up to 10 days

Study Arms (2)

Standard clinical pathway

NO INTERVENTION

A standard clinical pathway for TKA has been compulsively implemented for medical cost containment and quality assurance to meet with the Taiwan Diagnosis-Related Groups (TW-DRGs) payment system since 1997. The clinical pathway for TKA undertakes with preadmissions, anesthetic, surgery, and physiotherapy assessment. Medical, nursing, and physiotherapy assessment were put down for each postadmission day. The time from admission to surgery, the use of intravenous antibiotics injection and intravenous fluid were all assessed. Discharge criteria were active knee flexion to 90 degrees, having the ability to walk with aids and clean wound condition with any infection sign. The pathway was initially set for a 6-day postoperative length of stay.

Patient Infotainment Terminal

EXPERIMENTAL

Patients who have additional access to an integrated infotainment system and are cared by a standard clinical pathway. The patient infotainment system is a quasi-interactive computer program connected to a server that pushes messages and educational programs ordered from the caring physicians or on-demand by the patients. The server has parallel data exchange gateways to the Hospital Information System (HIS), Picture Archiving Communication System (PACS), and can record the patients' responses to surveys and questionnaires.

Device: Patient infotainment system

Interventions

Patient infotainment system DEVICE

The patient infotainment system is a quasi-interactive computer program connected to a server that pushes messages and educational programs ordered from the caring physicians or on-demand by the patients. The server has parallel data exchange gateways to the Hospital Information System (HIS), Picture Archiving Communication System (PACS), and can record the patients' responses to surveys and questionnaires.

Patient Infotainment Terminal

Eligibility Criteria

• Age: 20 Years - 75 Years
• Sex: all
• Healthy Volunteers: No
• Age Groups: Adult (18-64), Older Adult (65+)

You may qualify if:

• Admission to the hospital, scheduled for total joint replacement surgery
• Sign informed consent form

You may not qualify if:

• In-patient, not scheduled for total joint replacement surgery
• Any psychological condition or other condition that may influence the study result

Sponsors & Collaborators

• Chang Gung Memorial Hospital: lead

Study Sites (1)

Kaohsiung Chang Gung Memorial Hospital

Kaohsiung City, 83301, Taiwan

Location

MeSH Terms

Conditions

Behavior

Study Officials

• Mel S Lee, MD,PhD

  Chang Gung Memorial Hospital

  PRINCIPAL INVESTIGATOR

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: NON RANDOMIZED
• Masking: SINGLE
• Who Masked: OUTCOMES ASSESSOR
• Purpose: HEALTH SERVICES RESEARCH
• Intervention Model: PARALLEL
• Sponsor Type: OTHER
• Responsible Party: SPONSOR

Study Record Dates

• First Submitted: December 13, 2018
• First Posted: December 28, 2018
• Study Start: March 8, 2016
• Primary Completion: July 19, 2017
• Study Completion: March 7, 2018
• Last Updated: December 28, 2018

Record last verified: 2018-03

Data Sharing

• IPD Sharing: Will not share

Locations

TW (1)