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Reducing Preventable Emergency Department Visits After Colorectal Surgery by Improving Patient-Physician Communication Using Mobile Health Applications.

Record Type:	Electronic resources : Monograph/item
Title/Author:	Reducing Preventable Emergency Department Visits After Colorectal Surgery by Improving Patient-Physician Communication Using Mobile Health Applications./
Author:	Eustache, Jules.
Published:	Ann Arbor : ProQuest Dissertations & Theses, : 2021,
Description:	92 p.
Notes:	Source: Masters Abstracts International, Volume: 83-10.
Contained By:	Masters Abstracts International83-10.
Subject:	Clinical trials. -
Online resource:	http://pqdd.sinica.edu.tw/twdaoapp/servlet/advanced?query=29043536
ISBN:	9798209934646

Reducing Preventable Emergency Department Visits After Colorectal Surgery by Improving Patient-Physician Communication Using Mobile Health Applications.
Eustache, Jules.

Reducing Preventable Emergency Department Visits After Colorectal Surgery by Improving Patient-Physician Communication Using Mobile Health Applications. - Ann Arbor : ProQuest Dissertations & Theses, 2021 - 92 p.

Source: Masters Abstracts International, Volume: 83-10.

Thesis (M.Sc.)--McGill University (Canada), 2021.

This item must not be sold to any third party vendors.

Introduction: Unplanned emergency department visits and readmissions after surgery are common and represent a significant cost burden on the healthcare system. A notable portion of these unplanned visits are the result of expected complications or normal recovery after surgery, suggesting that improved coordination and communication in the outpatient setting could help reduce unplanned healthcare utilization. Telemedicine applications have demonstrated significant benefits in improving patient-physician communication. The objective of this thesis was to assess if telemedicine applications could reduce unplanned emergency department visits and readmissions in postoperative colorectal patients.Methods: First, a systematic review was performed to assess current telemedicine interventions and their effect on emergency department visits and readmissions. Second, a retrospective cohort of all patients undergoing elective major abdominopelvic colorectal surgery from 2017-2019 were reviewed to assess the rate and reasons underlying emergency department visits after surgery. These visits were then graded on a spectrum of preventability to determine an overall rate of potentially preventable healthcare utilization. Lastly, we implemented a mobile phone app with a patient-physician communication feature and assessed its effect on potentially preventable ED visits after surgery in a prospective cohort by comparing it to a retrospective cohort using coarsened-exact matching.Results: 29 studies were included in the systematic review and meta-analysis. There was no overall reduction in 30-day ED visit in the telemedicine group (RR: 0.89, 95%CI: 0.70 - 1.12). There was no overall reduction in 30-day readmissions either (RR: 0.90, 95%CI: 0.74 - 1.09). In the retrospective cohort, 625 patients were included in the final analysis of which 110(17.6%) patients presented to the ED within 30 days. After review, 51.8% of visits were considered potentially preventable. The most common causes of preventable ED visits were superficial wound infection (24.6%), non-infectious gastrointestinal issues (19.3%), and minor bleeding (14.0%). Lastly, our prospective cohort study demonstrated that the use of a mobile app was associated with fewer preventable ED visits (IRR 0.34, p=0.043) and shorter LOS (3.2 vs. 4.6 days, p=0.011) after colorectal surgery.Conclusion: Telemedicine has variable outcomes throughout surgery, suggesting that surgical specialties with a moderate-high return rate and a significant proportion of potentially preventable visits are likely to represent the best targets for telemedicine-based interventions. Colorectal surgery in our center has both features. Finally, use of a mobile app was associated with fewer potentially preventable ED visits and shorter length of stay after major elective colorectal surgery, likely due to enhanced post-discharge monitoring and patient-provider communication.

ISBN: 9798209934646Subjects--Topical Terms:

724498
Clinical trials.

Reducing Preventable Emergency Department Visits After Colorectal Surgery by Improving Patient-Physician Communication Using Mobile Health Applications.
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520 $a Introduction: Unplanned emergency department visits and readmissions after surgery are common and represent a significant cost burden on the healthcare system. A notable portion of these unplanned visits are the result of expected complications or normal recovery after surgery, suggesting that improved coordination and communication in the outpatient setting could help reduce unplanned healthcare utilization. Telemedicine applications have demonstrated significant benefits in improving patient-physician communication. The objective of this thesis was to assess if telemedicine applications could reduce unplanned emergency department visits and readmissions in postoperative colorectal patients.Methods: First, a systematic review was performed to assess current telemedicine interventions and their effect on emergency department visits and readmissions. Second, a retrospective cohort of all patients undergoing elective major abdominopelvic colorectal surgery from 2017-2019 were reviewed to assess the rate and reasons underlying emergency department visits after surgery. These visits were then graded on a spectrum of preventability to determine an overall rate of potentially preventable healthcare utilization. Lastly, we implemented a mobile phone app with a patient-physician communication feature and assessed its effect on potentially preventable ED visits after surgery in a prospective cohort by comparing it to a retrospective cohort using coarsened-exact matching.Results: 29 studies were included in the systematic review and meta-analysis. There was no overall reduction in 30-day ED visit in the telemedicine group (RR: 0.89, 95%CI: 0.70 - 1.12). There was no overall reduction in 30-day readmissions either (RR: 0.90, 95%CI: 0.74 - 1.09). In the retrospective cohort, 625 patients were included in the final analysis of which 110(17.6%) patients presented to the ED within 30 days. After review, 51.8% of visits were considered potentially preventable. The most common causes of preventable ED visits were superficial wound infection (24.6%), non-infectious gastrointestinal issues (19.3%), and minor bleeding (14.0%). Lastly, our prospective cohort study demonstrated that the use of a mobile app was associated with fewer preventable ED visits (IRR 0.34, p=0.043) and shorter LOS (3.2 vs. 4.6 days, p=0.011) after colorectal surgery.Conclusion: Telemedicine has variable outcomes throughout surgery, suggesting that surgical specialties with a moderate-high return rate and a significant proportion of potentially preventable visits are likely to represent the best targets for telemedicine-based interventions. Colorectal surgery in our center has both features. Finally, use of a mobile app was associated with fewer potentially preventable ED visits and shorter length of stay after major elective colorectal surgery, likely due to enhanced post-discharge monitoring and patient-provider communication.
520 $a Introduction: Les visites non planifiees aux urgences et les readmissions apres une chirurgie sont courantes et representent un fardeau financier important pour le systeme de sante. Une partie notable de ces visites non planifiees est le resultat de complications attendues ou d'une recuperation normale apres la chirurgie, ce qui suggere qu'une coordination et une communication ameliorees avec les patients ambulatoires pourraient aider a reduire l'utilisation non planifiee des soins de sante. Les applications de telemedecine ont demontre des avantages significatifs dans l'amelioration de la communication entre patient et medecin. L'objectif de cette these etait d'evaluer si les applications de telemedecine pouvaient reduire les visites non planifiees aux urgences et les readmissions chez les patients colorectaux postoperatoires.Methode: Premierement, une revue systematique a ete realisee pour evaluer les interventions de telemedecine actuelles et leur effet sur les visites aux urgences et les readmissions. Deuxiemement, une cohorte retrospective de tous les patients subissant une chirurgie colorectale abdomino-pelvienne majeure elective de 2017 a 2019 a ete revue pour evaluer le taux et les raisons sous-tendant les visites aux urgences apres la chirurgie. Ces visites ont ensuite ete classees selon un spectre d'evitable a nonevitable pour determiner un taux global d'utilisation des soins de sante potentiellement evitable. Enfin, nous avons mis en oeuvre une application de telephonie mobile avec une fonction de communication patient-medecin et evalue son effet sur les visites aux urgences potentiellement evitables apres une intervention chirurgicale dans une cohorte prospective en la comparant a une cohorte retrospective en utilisant l'appariement grossier-exact.Resultats: 29 etudes ont ete incluses dans la revue systematique et la meta-analyse. Il n'y avait pas de reduction globale du nombre de visites a l'urgence de 30 jours dans le groupe telemedecine (RR: 0,89, IC a 95%: 0,70 - 1,12). Il n'y avait pas non plus de reduction globale des readmissions a 30 jours (RR: 0,90, IC a 95%: 0,74 - 1,09). Dans la cohorte retrospective, 625 patients ont ete inclus dans l'analyse finale dont 110 (17,6%) patients se sont presentes a l'urgence dans les 30 jours. Apres examen, 51,8% des visites ont ete jugees potentiellement evitables. Les causes les plus courantes de visites a l'urgence evitables etaient l'infection des plaies superficielles (24,6%), les problemes gastro-intestinaux non infectieux (19,3%) et les saignements mineurs (14,0%). Enfin, notre etude de cohorte prospective a demontre que l'utilisation d'une application mobile etait associee a moins de visites a l'urgence evitables (IRR 0,34, p = 0,043) et a une duree de vie plus courte (3,2 vs 4,6 jours, p = 0,011) apres une chirurgie colorectale.Conclusion: La telemedecine a des resultats variables a travers les sous-specialites chirurgicales mais les etudes suggerent que les specialites chirurgicales avec un taux de retour aux urgences modere-eleve et une proportion significative de visites potentiellement evitables sont susceptibles de representer les meilleures cibles pour les interventions basees sur la telemedecine. La chirurgie colorectale dans notre centre presente ces deux caracteristiques. Enfin, l'utilisation d'une application mobile etait associee a moins de visites a l'urgence potentiellement evitables et a une duree de sejour plus courte apres une chirurgie colorectale elective majeure, probablement en raison de l'amelioration du suivi post-conge et de la communication patient et medecin.
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