Effect of Home Monitoring via Mobile App on the Number of In-Person Visits Following Ambulatory Surgery: A Randomized Clinical Trial.
In the age of information and patient-centered care, new methods of delivering postoperative care must be developed and evaluated.



To determine whether follow-up care delivered via a mobile app can be used to avert in-person follow-up care visits compared with conventional, in-person follow-up care in the first 30 days following ambulatory surgery.



A randomized clinical trial was conducted from February 1 to August 31, 2015, among ambulatory patients undergoing breast reconstruction at an academic ambulatory care hospital. Patients were randomly assigned to receive follow-up care via a mobile app or at an in-person visit during the first 30 days after the operation. Analysis was intention-to-treat.



The primary end point was the number of in-person follow-up visits during the first 30 days after the operation. Secondary end points were the number of telephone calls and emails to health care professionals, patient-reported convenience and satisfaction scores, and rates of complications.



Of the 65 women in the study (mean [SD] age, 47.7 [13.4] years), 32 (49%) were in the mobile app group, and 33 (51%) were in the in-person follow-up care group. Those in the mobile app group attended a mean of 0.66 in-person visits, vs 1.64 in-person visits in the in-person follow-up care group, for a difference of 0.40 times fewer in-person visits (95% CI, 0.24-0.66; P < .001) and sent more emails to their health care professionals during the first 30 days after the operation (mean, 0.65 vs 0.15; incidence rate ratio, 4.13; 95% CI, 1.55-10.99; P = .005) than did patients in the in-person follow-up care group. This statistically significant difference was maintained at 3 months postoperatively. The mobile app group reported higher convenience scores than the in-person follow-up care group (incidence rate ratio, 1.39; 95% CI, 1.09-1.77; P = .008). There was no difference between groups in the number of telephone communications, satisfaction scores, or complication rates.



Patients undergoing ambulatory breast reconstruction can use follow-up care via a mobile app to avert in-person follow-up visits during the first 30 days after the operation. Mobile app follow-up care affects neither complication rates nor patient-reported satisfaction scores, but it improves patient-reported convenience scores.



clinicaltrials.gov Identifier: NCT02318953.
Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada.
Kathleen A
KA
Armstrong
Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.
Peter C
PC
Coyte
Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada.
Mitchell
M
Brown
Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada.
Brett
B
Beber
Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada3Women's College Research Institute, Women's College Hospital, University of Toronto, Toronto, Ontario, Canada.
John L
JL
Semple
D000328:Adult; D000359:Aftercare / Q000379:methods*; D000556:Ambulatory Surgical Procedures / Q000009:adverse effects; D017558:Elective Surgical Procedures / Q000009:adverse effects; D034742:Electronic Mail / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D016462:Mammaplasty / Q000009:adverse effects; D008875:Middle Aged; D063731:Mobile Applications / Q000706:statistics & numerical data; D009819:Office Visits / Q000706:statistics & numerical data*; D017060:Patient Satisfaction; D013689:Telephone / Q000706:statistics & numerical data