Editor's note: This story was updated on May 7, 2019.
The patient pathway for most orthopaedic procedures has been largely unchanged for decades: patients attend pre-operative visits, then the surgery itself, and then ongoing post-op check-ins to assess their recovery.
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That was until Dr. Bibhas Roy, an orthopaedic surgeon at Manchester University NHS Foundation Trust in the UK, noticed two glaring problems with the process. First, patients disliked making so many visits to the hospital and orthopaedic clinic. Second, Roy and his colleagues were spending significant time in follow-up visits for patients who were recovering just as expected, preventing the doctors from performing surgeries on other patients.
After mapping out the pathway, Roy realised that there was a common solution to these two problems: a virtual model to improve the patient experience and enable top-of-license care post-surgery. With that, Roy and his team developed PROMs 2.0, a virtual assessment and communication system that is revolutionising follow-up care efficiency.
Using virtual care to streamline post-surgical follow-up
Here's how PROMs 2.0 works:
Three months after surgery, patients receive an email prompt to complete a short survey with questions like, "During the past four weeks have you had any trouble dressing yourself because of your shoulder?" The PROMs 2.0 algorithm then compares each patient's responses to validated Patient Reported Outcome Measures (PROMs) benchmarks, such as the Oxford Shoulder Score. Using this comparison, PROMs 2.0 determines whether a patient's post-surgical recovery is progressing as expected. If so, the system recommends that the patient does not need to return for in-person follow-up.
After the assessment, a clinician calls the patient to communicate the algorithm's results and tell him or her whether in-person follow-up is recommended. One might expect junior staff to make these phone calls, but Roy has found that it's actually more effective to have senior clinicians do so. This is because less experienced staff tend to be risk-averse and more likely to override the algorithm's assessment, suggesting in-person care even when it's not necessary.
A win for providers, patients, and payers
At any step, patients can opt for a face-to-face appointment, but most patients choose not to. In fact, 90% of patients who are progressing as expected choose not to return for in-person follow-up. This translates to 75% of all patients in the clinic who avoid unnecessary visits.
This freed-up capacity enables providers to perform more surgeries and devote valuable time and resources to patients who most need support. And it's not just beneficial for clinicians; patients love the convenience, resulting in patient experience scores of 14.4 out of 15 for the clinic.
The virtual service has also proven to be a win for the local health care economy. Because the virtual interactions are less costly than in-person visits, the model has resulted in cost savings for the local payer. To share these savings, the payer and hospital negotiated a payment specifically for the virtual interactions that's half the price of the payment for in-person visits.
Replicating the success of PROMs 2.0
Promisingly, the model also has the potential to be applied to services beyond orthopaedics. In fact, organisations looking to replicate the success of the virtual service can apply the PROMs 2.0 model to any health care service that meets three key criteria:
- High volumes, making the investment in virtual infrastructure cost-effective;
- Predictable patient pathway most of the time, so the algorithm can be relatively simple; and
- Field with robust outcome measures, which can be used for comparison.
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Flooded emergency departments are the new normal. However, data show that 30% to 50% of ED presentations are unnecessary and could be dealt with in primary or community care. With patients getting sicker and expecting more convenience from providers, it's no surprise that they bypass primary care for an easily accessible, one-stop-shop option like the ED.
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