Connected care: A telehealth and patient-reported outcome measure-based model for post-arthroplasty follow-up in a public hospital system

Abstract

Background

Rising demand for total hip arthroplasty (THA) and total knee arthroplasty (TKA) places significant pressure on healthcare systems. Routine in-person follow-up is resource-intensive and may limit access for new or higher priority patients. The Connected Care protocol integrates telehealth with patient-reported outcome measures (PROMs) to support a more efficient and patient-centred model of post-operative care.

Methods

Over 2 years in a public health institution, all THA and TKA patients completed routine pre-operative and post-operative PROMs. Patients scoring ≤27 on the Oxford hip score or Oxford knee score, and/or requested further clinical review, were triaged to telehealth consultation. Following telehealth assessment, patients were either booked for face-to-face review, discharged from routine follow-up, or managed with ongoing remote monitoring.

Results

1272 patients returned PROMs. Of these, 451 patients (35.5%) scored ≤27 and/or requested further review. Following telehealth consultation, 47 (10.4%) were discharged from face-to-face care, while 71 (15.7%) previously discharged had appointments reinstated for timely in-person review. Among 821 patients (64.5%) who scored >27 and did not request further review, 169 (20.6%) had pre-existing face-to-face appointments cancelled. Overall, the Connected Care protocol generated 216 additional orthopaedic outpatient appointment slots over the 24-month period.

Discussion

PROM-guided telehealth triage enabled risk-stratified, patient-centred follow-up post-THA/TKA, improving outpatient capacity within a publicly funded orthopaedic service. It reduced low-value outpatient encounters while preserving access to face-to-face care when clinically indicated. Future development should incorporate post-operative radiographic review, extend the model to other orthopaedic pathways, and enhance cultural and linguistic accessibility to support equitable digital post-operative care.