Effectiveness of an Automated Digital Remote Guidance and Telemonitoring Platform on Costs, Readmissions, and Complications After Hip and Knee Arthroplasties

Abstract Background The impact of a new class of automated digital patient engagement (DPE) platforms on potentially avoidable costs, hospital admissions, and complications after discharge following hip and knee arthroplasties has not been established. Methods We conducted a multicenter observational cohort study comparing claims data for potentially avoidable costs, hospital admissions, and complications for 90 days after discharge following hip and knee arthroplasties at 10 practice sites in CA and NV. One hundred eighty-six patients, enrolled between 2014 and 2016 on an automated DPE platform receiving guidance and remote monitoring perioperatively, were compared with 372 patients who underwent the same procedures from the same physicians within 3 years immediately preceding platform implementation. The primary end point was the proportion of patients with $0.00 in 90-day target costs because of potentially avoidable utilization within the platform's influence. Secondary end points included rates of potentially avoidable 90-day hospital admissions and composite complications. Results Ninety-three percent and 84.7% of the study and baseline cohorts, respectively, had $0.00 in target costs ( P  = .004), with a mean savings of $656.52/patient ( P  = .006). The baseline and study cohorts had 3.0% and 1.6% 90-day hospital admission rates (relative risk 0.545; 0.154, 1.931, P  = .40), and 15.3% and 7.0% composite complication rates, respectively (relative risk 0.456; 0.256, 0.812, P  = .004). Conclusion Patients enrolled on an automated DPE platform after hip and knee arthroplasties demonstrated a significant reduction in potentially avoidable 90-day costs, a 45.4% nonsignificant relative reduction in 90-day hospital admissions, and a 54.4% significant relative reduction in 90-day complications.