A systematic review published this past week in npj Digital Medicine examined the use of mobile and wearable digital health interventions to monitor patients after surgery.  

For the paper, University of Edinburgh researchers dug into 44 studies in which patients had been postoperatively monitored with a digital health intervention (DHI) after discharge from the hospital.   

The team found that although using digital health interventions in this context may be helpful, several issues persist with regard to reporting that must first be addressed.  

"To our knowledge, this is the first systematic review to have investigated the use and effectiveness of mobile DHI in postsurgical care, including a rigorous assessment of current reporting quality," they wrote.  

WHY IT MATTERS

As noted by the researchers, post-discharge complications after surgery can interfere with patient recovery and even lead to hospital readmission.  

The team reviewed 44 articles that investigated the use of digital health tools in a post-surgical setting.  

Most of the studies were conducted in the United States, and only one originated from what researchers called a "low- or middle-income setting."  

Interventions predominantly took place in the first 30 days after surgery, with real-time data collection and delivery occurring in 31 studies.

The majority used a mixture of mobile phone-based interventions, with about half turning to smartphone apps. Others relied on wearables such as Fitbits or smartwatches.  

Differences in methodology and outcome definitions limited the team's conclusions as to the effectiveness of digital health interventions.  

"However, DHI demonstrated a strong ability to track postoperative analgesic requirements and patient recovery, while consistently reducing hospital resource use in the postoperative period," observed researchers.   

"The capture of longer-term outcomes were also possible beyond 30 days, particularly for orthopedic procedures and to monitor weight loss," they added.   

"DHI were also able to identify complications at an early stage and correctly classify wound infection in the majority of patients, demonstrating good agreement with physicians," they wrote.  

At the same time, the study found that reporting quality was "suboptimal," especially when it came to data security, cost assessment and patient engagement during intervention development.

Transparency was also an issue.  

"Companies often have a market strategy that relies on proprietary algorithms and closed data sets, making it difficult to evaluate these innovations," wrote the researchers. "This problem is exacerbated when such algorithms are updated, complicating longitudinal comparisons of measures even within the same brand device." 

"We recommend further research investment in Open Software and the sharing of appropriately anonymized datasets for meta-analysis, to encourage sustainable and trustworthy innovations of this type," they said.  

THE LARGER TREND  

Health systems have increasingly begun to rely on remote patient monitoring tools and digital health interventions to keep in contact with patients after discharge from the hospital.  

In 2018, for instance, Crittenton Hospital Medical Center told Healthcare IT News about its newly implemented workflow targeted at rural patients before and after surgery.  

"Digital technology can deliver content at set intervals and quantities that, for some, enhances understanding and retention," Crittenton's Dr. Nick Frisch said at the time.   

"Since content is delivered over time, the breadth can be expanded to include important topics that in a traditional clinical environment we may not have the capacity to discuss," he added.  

ON THE RECORD  

"In order to advocate for the widespread use of digital health in the monitoring of postoperative patient recovery, additional high-quality research is needed prior to integration into the healthcare environment," wrote researchers in the npj Digital Medicine article.   

"Particular attention to reporting quality is advised, to ensure these studies can be replicated and provide the opportunity for equitable comparison," they added.

Kat Jercich is senior editor of Healthcare IT News.
Twitter: @kjercich
Email: kjercich@himss.org
Healthcare IT News is a HIMSS Media publication.