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American Association for Hand Surgery

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Comparison of Patient Reported Outcomes Across 3 Care Delivery Models in Individuals Following Upper Extremity Surgery
Aviva L. Wolff, EdD, OT, CHT1, Christian Victoria, MPH2 and Daniel A Osei, MD2, (1)Hand and Upper Extremity Surgery, Hospital for Special Surgery, New York, NY, (2)Hospital for Special Surgery, New York, NY

PURPOSE: The purpose of this retrospective study was to compare patient reported outcomes in 3 care-delivery cohorts of post-operative upper extremity (UE) care: in person, telehealth, hybrid.
METHODS: Data was extracted from the electronic medical records of individuals who underwent UE surgery at a single institution between September 1, 2019 - September 30, 2020 for all post-operative visits conducted by hand clinicians (surgeons, therapists, PAs). Demographic data extracted included: age, race, ethnicity, and number of post-operative visits. Patient reported outcome measures included the Quick Disabilities of the Arm Shoulder Hand Score (Quick-DASH), PROMIS Global-10 Mental Health (PROMIS10-MH), and PROMIS Global-10 Physical Disabilities (PROMIS 10-PH) collected at 4 time points: pre-operatively, 6-weeks post-operatively, 3-months post-operatively, and 6-months post-operatively.
DATA ANALYSIS: Pearson's χ2 and Fisher's exact tests were used to analyze differences between categorical variables. Analysis of variance (ANOVA) was used to assess difference in continuous variables between groups, and Tukey's tests for pairwise comparisons (adjusted using the Bonferroni correction).
RESULTS: 2,384 individuals with UE surgeries were included. 53.1% were female and 77.5% were white, non-Hispanic. Mean age was 53.1±17.1. Average number of post-operative visits was 6±8.3. Last follow-up visit was 58± 82 days post-surgery. Care delivery model categorization indicated 71% in-person only, 27% combined telehealth and in-person, and 2% Telehealth only. A higher percentage of patients (71%) were female in the telehealth group (50.8% in-person, 58% hybrid categories (p<0.001). In-person participants were older (53.4±17.3) compared to hybrid patients (52.7±16.5) and telehealth (47.2±15.8, p=0.046). Hybrid group participants had more postoperative visits (9±10) than in-person (4±6), and telehealth patients (1± 2; p<0.001). Similarly, hybrid patients were in contact with a care provider longer (84 ± 83 days) than telehealth (50.6±58.2 days) or in-person (49.4±79.7 days; p<0.001). No differences were noted among Quick-DASH and PROM10-MH scores across time periods. However, preoperative PROM-10PH scores were worse (lower) among hybrid patients compared to telehealth patients (p=0.005).
CONCLUSIONS: Our findings of no broad differences in patient reported outcomes between care-delivery groups supports further study of personal preference of patients and clinicians, the cost and reimbursement of services, as well as individual patient, diagnostic and clinical factors that influence outcomes on a patient-specific level. Further analysis of the effect of individual factors on outcomes will help clinicians identify and select the care-delivery model to most benefit each individual patient.


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