Date of Award

2018

Document Type

Open Access Dissertation

Department

Health Services and Policy Management

Sub-Department

The Norman J. Arnold School of Public Health

First Advisor

Mahmud Khan

Abstract

Purpose: Assessment of health technologies in medical practice is an ongoing process to provide clinicians and policymakers with information on the value of those applications. This dissertation aims to add to the existing body of literature and fill the gaps in prior studies by assessing two health technologies in Mayo Clinic Florida (MCF). The first paper provides an assessment of patient portal adoption and activity during hospitalization among cancer patients, and determines whether a portal application is associated with selected indices of patient safety, utilization and satisfaction. The second paper provides an assessment of a new approach in pain management after total knee arthroplasty (TKA), a periarticular anesthetic injection (PAI), and compares patient outcomes postoperatively among those who had this new pain management approach versus the traditionally used approach of peripheral nerve blocks in a consecutive earlier period.

Methods: The first paper retrospectively reviewed all cancer inpatients admitted in MCF between 2012-2014 (N=4,594), compared portal adopters (i.e., who registered for a portal account) versus non-adopters, and compared inpatient portal activity among active versus inactive users. The second paper retrospectively reviewed consecutive patients who underwent primary unilateral TKA between March 1, 2013, and August 31, 2014 (N=511) and received FNB with SNB versus those who underwent TKA between October 1, 2014 and March 31, 2016 (N=479) and received PAI. In addition to descriptive statistics, postoperative outcomes, including pain scores, time to ambulation, distance walked, in-hospital falls, length of stay, discharge disposition, satisfaction with pain control, emergency visits within 14 days, readmissions within 30 days, revisions within 90 days, and total cost of hospitalization and 90-day follow-up period, were compared. SAS Version 9.4 was used for all analyses.

Results: We found that 2352 (51.1%) were portal adopters, and of them, 632 (26.8%) were active inpatient users. Adoption was influenced by predisposing and enabling factors, such as age, sex, race, marital status, employment status, income, and type of health insurance. Active inpatient use was similarly influenced by predisposing and enabling factors, such as age, race, and marital status, in addition to factors related to need, such as being sicker, nonlocal and admitted for medical treatment (P

Conclusion: Based on early evidence, cancer patients reached modest levels of portal adoption, with increased adoption associated with predisposing and enabling determinants, and increased inpatient use associated with need. In pain management after TKA, PAI was superior in providing early postoperative pain relief, improved functional recovery, better patient satisfaction with pain, and lower hospitalization cost compared to FNB with single-shot SNB following TKA. Findings may provide insight for clinicians and policymakers who are interested in health technology assessment and directing future research efforts on the value of care.

Rights

© 2018, Duaa I. Aljabri

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