The Orthopedic Blind Spot

Has this ever happened to you while driving?  Ready to switch lanes, you look over your shoulder then check the rearview mirror. All clear.  You begin to make your move, and out of nowhere comes the sound of a blaring horn. Heart pounding, you jerk the steering wheel and move back into your lane as quickly as possible. The other car was in your blind spot – you didn’t see the whole picture, and your attempted lane change could have ended badly.

Now imagine that same lack of visibility when evaluating a total joint arthroplasty (TJA) patient’s compliance with home therapy exercises. Most patients are given paper or video instructions and sent home to complete their prescribed activities. The clinician is left to wonder if the patient will adhere to the protocol. Is the patient moving the joint and how much? Is the range-of-motion (ROM) where it needs to be?  Is the patient in too much pain? About 40 percent of patients do not complete home therapy1,2, sending the clinician scrambling to get the patient back in the right lane to a desired outcome. The pathway to an undesirable outcome is paved with “what-ifs” and “if I had only known sooner” statements.  Much like a driver behind the wheel of a car, clinicians are dealing with a blind spot in a patient’s at-home recovery.

The current healthcare movement toward value-based care is leading to increased focus on data collection to remove the blind spots. Specifically in the TJA episode, most organizations are gathering detailed data from the time of the pre-op appointment through surgery discharge.  This data includes hospital (supplies, medication, staff hours), procedure (operating room time, anesthesia, surgeon fee, hardware/device cost) and inpatient stay (nurse, medication, room, food, etc.).

The transition from detailed, objective data capture to subjective data capture occurs largely after discharge from the hospital. Current methods of data gathering for therapy progress are subjective at best: a) patient post-op visits to surgeon; b) self-attested exercise completion; c) functional performance data collected during PT visits; or d) patient self-reported outcomes collected before and after surgery. This data is primarily collected during in person visits and is a lagging indicator of success.

This gap in objective data gathering leads to the largest blind spot in the TJA orthopedic episode. Lack of visibility creates the following significant challenges for the patient, care team and organization that can add up to over $1,000 in added cost to the episode1, including:

  • Being unaware when a patient is having trouble with at-home recovery
  • Reacting to patient outcomes vs. being proactive to real data
  • Selecting higher cost therapy settings (Skilled Nursing Facility or Home Health Aid) due to fear of sending patients home without actionable monitoring
  • Experiencing longer timeframes for a patient to reach a good outcome
  • Using avoidable emergency department visits due to pain, medication issues, etc.
  • Adding costs due to revisions and manipulations for patients unable to reach a good outcome
  • Decreasing patient satisfaction
  • Failing to reach bundled care cost objectives, subject to penalties and poor payer profiles

With the advent of Breg Flex™ mobile patient monitoring and sensor technology, the capture of real-time objective data provides a first-of-its kind solution for caregivers to see what they can’t today. This includes exercise completion (adherence), distance moved per exercise (delta), precise ROM measurements ((+/-) 5 degrees) and VAS pain scores. Capturing this objective data has the opportunity to remove the blind spot. Caregivers can now see exactly how a patient is tracking and intervene if needed. Data leads to numerous benefits and greatly helps organizations reach their Triple Aim2 goals:

Lower costs:

  • Standardized care and protocols, backed by evidence based data
  • Reduction of unneeded visits and staff time spent on gathering data from patients during appointments
  • Reduction of emergency department visits due to pain and/or medication issues
  • Faster recovery time leading to reduction of time from hurt to healthy
  • Reduction of post-acute spending on higher cost therapy because patient moves to the home setting more quickly

Improved outcomes:

  • Real time, objective data leads to proactive vs. reactive care
  • Patients reach their functional performance goals faster, and stay on track to recovery
  • Reduction in number of revisions, manipulation under anesthesia (MUA) due to improved outcomes

Enhanced patient satisfaction:

  • Home setting is preferred by many patients
  • Patients feel cared for and engaged by being connected to clinical team
  • Motivating experience with real time feedback and communication
  • Less resources spent driving to and from appointments; flexibility to fit therapy into patients’ schedules

To remove the blind spot you need more data for a better perspective. When driving a car this means upgrading to driver assist technology − or investing in a convertible. In orthopedics, this means gaining reliable, actionable data using remote therapy monitoring. The value from seeing the big picture is nothing short of significant.

Article by Robert Haywood, Breg Senior Marketing Manager

1 Bassett SF (2003). The assessment of patient adherence to physiotherapy rehabilitation. NZ J Physiother, 31: 60–66
2 Wright BJ, Galtieri NJ, & Fell M. (2014). Non-adherence to prescribed home rehabilitation exercises for musculoskeletal injuries: the role of the patient- practitioner relationship. Journal of Rehabilitative Medicine, 46(2): 153–158

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