A Smartphone App With a Digital Care Pathway for Patients Undergoing Spine Surgery: Development and Feasibility Study

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Abstract

Background

There is a great unmet clinical need to provide patients undergoing spinal surgery and their caregivers with ongoing, high-quality care before and after surgery in an efficiency-focused health care environment.

Objective

The objective of this study is to design, develop, and evaluate the acceptability and feasibility of a novel planning-, outcomes-, and analytics-based smartphone app called ManageMySurgery (MMS) in patients undergoing elective spine surgery (MMS-Spine).

Methods

The development process of the MMS app was conducted over 2 sequential stages: (1) an evidence-based intervention design with refinement from surgeon and patient feedback and (2) feasibility testing in a clinical pilot study. We developed a novel, mobile-based, Health Insurance Portability and Accountability Act–compliant platform for interventional and surgical procedures. It is a patient-centric mobile health app that streamlines patients’ interactions with their care team. MMS divides the patient journey into phases, making it feasible to provide customized care pathways that meet patients’ unique needs. Patient-reported outcomes are easily collected and conform to the National Institutes of Health Patient-Reported Outcomes Measurement Information System (PROMIS) standard.

Results

We tested the feasibility of the MMS-Spine app with patients undergoing elective spine surgery at a large academic health system. A total of 47 patients undergoing elective spine surgery (26 cervical spine and 21 lumbar spine surgeries) downloaded and used MMS-Spine to navigate their surgical journey, quantify their baseline characteristics and postoperative outcomes, and provide feedback on the utility of the app in preparing for and recovering from their spinal surgery. The median age was 59.0 (range 33-77) years, 22 of the 47 patients (47%) were women, and 26 patients (55%) had commercial insurance. Of the 47 patients, a total of 33 (70%) logged in on an iOS device, 11 (23%) on an Android device, and 3 (6%) on a computer or tablet. A total of 17 of the 47 patients (36%) added a caregiver, of which 7 (41%) logged in. The median number of sign-ins was 2. A total of 38 of 47 patients (81%) completed their baseline preoperative PROMIS-29 outcomes, and 14 patients (30%) completed at least one PROMIS-29 survey during the postoperative period. Of the 24 patients who completed the MMS survey, 21 (88%) said it was helpful during preparation for their procedure, 16 (67%) said it was helpful during the postoperative period, and 23 (96%) said that they would recommend MMS to a friend or family member.

Conclusions

We used a patient-centered approach based on proven behavior change techniques to develop a comprehensive smartphone app for patients undergoing elective spine surgery. The optimized version of the app is ready for formal testing in a larger randomized clinical study to establish its cost-effectiveness and effect on patients’ self-management skills and long-term outcomes.

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Most cited references 21

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Engaging patients to improve quality of care: a systematic review

Yvonne Bombard, G Ross Baker, Elaina Orlando … (2018)

Background To identify the strategies and contextual factors that enable optimal engagement of patients in the design, delivery, and evaluation of health services. Methods We searched MEDLINE, EMBASE, CINAHL, Cochrane, Scopus, PsychINFO, Social Science Abstracts, EBSCO, and ISI Web of Science from 1990 to 2016 for empirical studies addressing the active participation of patients, caregivers, or families in the design, delivery and evaluation of health services to improve quality of care. Thematic analysis was used to identify (1) strategies and contextual factors that enable optimal engagement of patients, (2) outcomes of patient engagement, and (3) patients’ experiences of being engaged. Results Forty-eight studies were included. Strategies and contextual factors that enable patient engagement were thematically grouped and related to techniques to enhance design, recruitment, involvement and leadership action, and those aimed to creating a receptive context. Reported outcomes ranged from educational or tool development and informed policy or planning documents (discrete products) to enhanced care processes or service delivery and governance (care process or structural outcomes). The level of engagement appears to influence the outcomes of service redesign—discrete products largely derived from low-level engagement (consultative unidirectional feedback)—whereas care process or structural outcomes mainly derived from high-level engagement (co-design or partnership strategies). A minority of studies formally evaluated patients’ experiences of the engagement process (n = 12; 25%). While most experiences were positive—increased self-esteem, feeling empowered, or independent—some patients sought greater involvement and felt that their involvement was important but tokenistic, especially when their requests were denied or decisions had already been made. Conclusions Patient engagement can inform patient and provider education and policies, as well as enhance service delivery and governance. Additional evidence is needed to understand patients’ experiences of the engagement process and whether these outcomes translate into improved quality of care. Registration N/A (data extraction completed prior to registration on PROSPERO). Electronic supplementary material The online version of this article (10.1186/s13012-018-0784-z) contains supplementary material, which is available to authorized users.

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The one number you need to grow.

F Reichheld (2003)

Companies spend lots of time and money on complex tools to assess customer satisfaction. But they're measuring the wrong thing. The best predictor of top-line growth can usually be captured in a single survey question: Would you recommend this company to a friend? This finding is based on two years of research in which a variety of survey questions were tested by linking the responses with actual customer behavior--purchasing patterns and referrals--and ultimately with company growth. Surprisingly, the most effective question wasn't about customer satisfaction or even loyalty per se. In most of the industries studied, the percentage of customers enthusiastic enough about a company to refer it to a friend or colleague directly correlated with growth rates among competitors. Willingness to talk up a company or product to friends, family, and colleagues is one of the best indicators of loyalty because of the customer's sacrifice in making the recommendation. When customers act as references, they do more than indicate they've received good economic value from a company; they put their own reputations on the line. And they will risk their reputations only if they feel intense loyalty. The findings point to a new, simpler approach to customer research, one directly linked to a company's results. By substituting a single question--blunt tool though it may appear to be--for the complex black box of the customer satisfaction survey, companies can actually put consumer survey results to use and focus employees on the task of stimulating growth.

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Behavior Change Techniques and Their Mechanisms of Action: A Synthesis of Links Described in Published Intervention Literature

Rachel N. Carey, Lauren E Connell, Marie Johnston … (2018)

Abstract Background Despite advances in behavioral science, there is no widely shared understanding of the “mechanisms of action” (MoAs) through which individual behavior change techniques (BCTs) have their effects. Cumulative progress in the development, evaluation, and synthesis of behavioral interventions could be improved by identifying the MoAs through which BCTs are believed to bring about change. Purpose This study aimed to identify the links between BCTs and MoAs described by authors of a corpus of published literature. Methods Hypothesized links between BCTs and MoAs were extracted by two coders from 277 behavior change intervention articles. Binomial tests were conducted to provide an indication of the relative frequency of each link. Results Of 77 BCTs coded, 70 were linked to at least one MoA. Of 26 MoAs, all but one were linked to at least one BCT. We identified 2,636 BCT–MoA links in total (mean number of links per article = 9.56, SD = 13.80). The most frequently linked MoAs were “Beliefs about Capabilities” and “Intention.” Binomial test results identified up to five MoAs linked to each of the BCTs (M = 1.71, range: 1–5) and up to eight BCTs for each of the MoAs (M = 3.63, range: 1–8). Conclusions The BCT–MoA links described by intervention authors and identified in this extensive review present intervention developers and reviewers with a first level of systematically collated evidence. These findings provide a resource for the development of theory-based interventions, and for theoretical understanding of intervention evaluations. The extent to which these links are empirically supported requires systematic investigation.

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Author and article information

Contributors

Lefko T. Charalambous:

ORCID: https://orcid.org/0000-0003-0907-1254

Department of NeurosurgeryDuke University Medical Center30 Duke Medicine CircleDurham, NC, 27710United States1 919 613 0444lefko.charalambous@duke.edu

Journal

Journal ID (nlm-ta): JMIR Perioper Med

Journal ID (iso-abbrev): JMIR Perioper Med

Journal ID (publisher-id): JPeriOp

Title: JMIR Perioperative Medicine

Publisher: JMIR Publications (Toronto, Canada )

ISSN (Electronic): 2561-9128

Publication date Collection: Jul-Dec 2020

Publication date (Electronic): 16 October 2020

Volume: 3

Issue: 2

Electronic Location Identifier: e21138

Affiliations

[1 ] Higgs Boson Health Durham, NC United States

[2 ] Department of Neurosurgery Duke University Medical Center Durham, NC United States

Author notes

Corresponding Author: Lefko T. Charalambous lefko.charalambous@ 123456duke.edu

Author information

Madison Ponder https://orcid.org/0000-0002-4933-7216

Abena A. Ansah-Yeboah https://orcid.org/0000-0001-8563-9492

Lefko T. Charalambous https://orcid.org/0000-0003-0907-1254

Syed M. Adil https://orcid.org/0000-0002-2322-5478

Vishal Venkatraman https://orcid.org/0000-0002-3485-4026

Muhammad Abd-El-Barr https://orcid.org/0000-0001-7151-2861

Michael Haglund https://orcid.org/0000-0002-6332-0808

Peter Grossi https://orcid.org/0000-0003-3461-3190

Chester Yarbrough https://orcid.org/0000-0003-0546-6435

Rajeev Dharmapurikar https://orcid.org/0000-0002-4491-0642

Ziad Gellad https://orcid.org/0000-0002-7212-3304

Shivanand P. Lad https://orcid.org/0000-0003-4991-5319

Article

Publisher ID: v3i2e21138

DOI: 10.2196/21138

PMC ID: 7709850

PubMed ID: 33393924

SO-VID: 560669d8-b615-4c86-a866-958ff295b5bb

Copyright © ©Madison Ponder, Abena A. Ansah-Yeboah, Lefko T. Charalambous, Syed M. Adil, Vishal Venkatraman, Muhammad Abd-El-Barr, Michael Haglund, Peter Grossi, Chester Yarbrough, Rajeev Dharmapurikar, Ziad Gellad, Shivanand P. Lad. Originally published in JMIR Perioperative Medicine (http://periop.jmir.org), 16.10.2020.

License:

This is an open-access article distributed under the terms of the Creative Commons Attribution License ( https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work, first published in JMIR Perioperative Medicine, is properly cited. The complete bibliographic information, a link to the original publication on http://periop.jmir.org, as well as this copyright and license information must be included.

History

Date received : 13 June 2020

Date revision requested : 23 August 2020

Date revision received : 29 August 2020

Date accepted : 30 August 2020

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