GreenCare Interactive Guide for Knee Replacement Surgery

Project SummaryAbstract The goal of this Phase I work is to finish development of an innovative interactive app designed to help patients appropriately use total knee replacementTKRsurgery and provide support to achieve best outcomesTKR is highly effective for treating advanced osteoarthritis of the kneebut it has risksAppropriate use can be assured by engaging patients in a Shared Decision MakingSDMprocess to help them fully understand risks and benefits of different treatmentsDecision aids typically present average benefits and riskswithout personalizing information for unique patient features that may influence outcomesCurrentlythere is no valid tool for individualizing prognosis following TKRFurthermoreimplementing SDM is difficult in the dynamicfast movingstressful clinic environment of face to face visits with surgeonsMobile technologies offer a potential solutionWe are developing a mobile and web application that has interactive features and communication tools to empower patients considering knee replacement surgeryThe App uses validated Patient Reported OutcomePROmeasures to present time trends for health status measures such as pain and functionIt provides reference values for these scores so patients can gauge how they are doing compared to othersBy answering a few questions about agesexweightheightand health status measured by PROspatients can see how they compare to adults in the Unites States and TKR patients similar to themThese comparisons may help them decide if surgery is right for themPatients have the option to share PRO data with their providersThe App leverages validated prediction models that present individualized prognosis for key outcomesPatients can see personalized estimates of predicted physical function and pain following surgeryand other outcomes such as risk of infectionreadmission and repeat surgeryBy dialing in changes for modifiable risk factorssuch as weighttobacco alcohol useand baseline physical function scorepatients can see the potential impact of these lifestyle changes on outcomesWe have developed a prototype that solves the technological challenges for HIPAA compliancesecure communicationidentity validationand sharing PROs with one electronic health recordHoweverusability tests showed that patients found it difficult to navigate features independently and understand PRO scoresWe propose to redesign the user experience and user interface in Phase I such that patients can directly track their outcomes over timeand leverage standardized PRO score presentation methods developed by the NIH PROMIS program s Computerized Adaptive TestingCATto clearly present PRO scoresImproved usability will prepare the App for market and examining real world use by patients going through the TKR treatment journeyThe technology will then be ready for assessment of its impact on patient experience and outcomesand the hypothesis that convenientpersonalized support motivates more appropriate usebetter experienceand better outcomes for TKR Project Narrative Osteoarthritis of the knee is a major and growing source of disabilitypain and loss of quality of lifeKnee replacement surgery is a highly effective treatmentbut it has risksand one in five patients are not satisfied with the resultsWe are developing an interactive mobile and web app that empowers patients to engage their providers in shared decision making conversationsThe proposed PhaseSBIR work will improve user experience and usability of the application and lay the groundwork for bringing it to market