After a Total Hip Arthroplasty (THA), post-discharge contact moments with care providers may be scarce. Online resources may offer support, but Human Factors Engineering methods are needed to tailor these resources to patients’ varying post-surgery information needs. In order to evaluate tailored components in a web application and to refine guidelines for tailored Information Technology (IT) in healthcare, the authors developed a tailored web application for THA patients. The web application informs THA patients about recommended activity levels in the first months after surgery using individualized thresholds based on daily step counts. The feedback given by the application is designed in three variants that match characteristics from three different THA patient subgroups (profiles) defined in previous research. To investigate the use and evaluation of this application, a small-scale qualitative study (20 patients, 3 care providers) will be conducted. Results will include qualitative feedback from patients and care providers, as well as metrics describing participants’ use of the application. This paper discusses the study methodology, including the application used.

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Objective: Tailored communication and information provision is expected to contribute to patient-centred care (PCC) in total hip arthroplasty (THA). In previous research, three subgroups of THA patients were identified that are similar in their clinical, psychological and communication characteristics. Preliminary subgroup-specific design guidelines were also formulated.
Using these insights as a starting point, a theoretical framework was developed for tailored information provision and communication using digital applications. This study aims to refine the framework as well as subgroup-specific design
guidelines for digital applications.

Methods: This study uses a Research through Design (RtD) approach, generating insights both from the development and evaluation of prototypes in the early design stage. Paper-based prototypes will be made for each subgroup and evaluated with patients and care providers. Semi-structured interviews are held with participants exploring their experiences with the prototype. A quasi-experiment with a non-random control cohort is used to validate the qualitative findings. Post-surgery consultations with and without prototype are videotaped and scored using a structured instrument.

Results: A design diary will be used to summarize design decisions and considerations. Feedback from participants is analysed inductively. Adaptations in subgroup-specific guidelines will be based on comparison of verbal feedback and descriptive statistics from consultations with and without prototype.

Conclusions: Although mixed-method feasibility studies of digital health interventions are common, this protocol also considers the utility of the early design process and the designer’s perspective for realizing PCC and tailored care.@en

To achieve optimal patient-centered care for people undergoing a Total Hip Arthroplasty (THA), communication should ideally be tailored. In previous studies, three clusters of patients or patient ‘roles’ were identified based on communication preferences and clinical and psychological characteristics as a starting point for tailored communication in orthopedics. The current study aims to formulate initial guidelines for the design of tailored communication and information provision based on these roles. Two design cases were each evaluated as storyboards with twelve patients (three, seven, and two patients of each role, respectively). Generic and functionality-specific preferences were indicated by participants for both design proposals. Similarities in feedback per role provided the basis for generating an initial set of role-specific guidelines, that can be used to design tailored information and communication solutions.

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Introduction: Although the clinical attributes of total hip arthroplasty (THA) care pathways have been thoroughly researched, a detailed understanding of the equally important organisational attributes is still lacking. The aim of this article is to contribute with a model of the outpatient THA care pathway that depicts how the care team should be organised to enable patient discharge on the day of surgery. Theory: The outpatient THA care pathway enables patients to be discharged on the day of surgery, shortening the length of stay and intensifying the provision and organisation of care. We utilise visual care modelling to construct a visual design of the organisation of the care pathway. Methods: An embedded case study was conducted of the outpatient THA care pathway at a teaching hospital in the Netherlands. The data were collected using a visual care modelling toolkit in 16 semi-structured interviews. Problems and inefficiencies in the care pathway were identified and addressed in the iterative design process. Results: The results are two visual models of the most critical phases of the outpatient THA care pathway: diagnosis & preparation (1) and mobilisation & discharge (4). The results show the care team composition, critical value exchanges, and sequence that enable patient discharge on the day of surgery. Conclusion: The design addressed existing problems and is an optimisation of the case hospital’s pathway. The network of actors consists of the patient (1), radiologist (1), anaesthetist (1), nurse specialist (1), pharmacist (1), orthopaedic surgeon (1,4), physiotherapist (1,4), nurse (4), doctor (4) and patient application (1,4). The critical value exchanges include patient preparation (mental and practical), patient education, aligned care team, efficient sequence of value exchanges, early patient mobilisation, flexible availability of the physiotherapist, functional discharge criteria, joint decision making and availability of the care team.@en

Background: Cell salvage is used to reduce allogeneic red blood-cell (RBC) transfusions in total hip arthroplasty (THA) and total knee arthroplasty (TKA). We performed a meta-analysis to assess the effectiveness of cell salvage to reduce transfusions in THA and TKA separately, and to examine whether recent trials change the conclusions frompreviousmeta-analyses. Methods: We searched MEDLINE through January 2013 for randomized clinical trials evaluating the effects of cell salvage in THA and TKA. Trial results were extracted using standardized forms and pooled using a random-effects model. Methodological quality of the trials was evaluated using the Cochrane Collaboration's tool for risk-of-bias assessment. Results: Forty-three trials (5631 patients) were included. Overall, cell salvage reduced the exposure to allogeneic RBC transfusion in THA (risk ratio [RR], 0.66; 95% confidence interval [CI], 0.51 to 0.85) and TKA (RR, 0.51; 95% CI, 0.39 to 0.68). However, trials published in 2010 to 2012, with a lower risk of bias, showed no significant effect of cell salvage in THA (RR, 0.82; 95% CI, 0.66 to 1.02) and TKA (RR, 0.91; 95% CI, 0.63 to 1.31), suggesting that the treatment policy regarding transfusion may have changed over time. Conclusions: Looking at all trials, cell salvage still significantly reduced the RBC exposure rate and the volume of RBCs transfused in both THA and TKA. However, in trials published more recently (2010 to 2012), cell salvage reduced neither the exposure rate nor the volume of RBCs transfused in THA and TKA, most likely explained by changes in blood transfusion management. Level of Evidence: Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.@en