Feasibility Study to Implement Quality Indicator Toolkits for Rehabilitation After Total Hip and Knee Replacement: Patient and Clinician Toolkit User Metrics

Objectives We developed evidence-based quality indicators (QIs) to address care gaps in total hip (THR) and knee replacement (TKR) rehabilitation.[1] To support implementation, patients (EQUIP) and clinician-friendly (QUICK-TJR) online toolkits were created. This paper assesses patients’ and clinicians’ use and views of the toolkits and relationship with QI adherence. Methods We gave clinicians access to the QUICK toolkit after 3 months of providing usual care and a training webinar. Six weeks later patients could access the EQUIP toolkit. Toolkit resources included videos, checklists, booklets and QUICK guides and were available to both groups for the duration of the study. We determined toolkit usage through Google analytics and post-intervention questionnaires. Questionnaire data were analyzed descriptively and exploratory analysis performed to examine relationship between toolkit access in past 3 months and adherence to 10 QIs. Analyses were conducted using SAS (V9.4, Cary, NC). Results In total, 46 patients participated in the study and 22 of them received THR/TKR rehabilitation during the toolkit implementation and maintenance phases. Of these, 12 completed end of rehabilitation questionnaires and 5 (42%) reported being introduced to the EQUIP toolkit. The most frequently accessed resources were the TKR (64 total views) and THR (48 total views) booklets (Figure 1). Overall, patients rated the QI questionnaire and video as being most helpful; 60% agreed the toolkit helped them understand what to expect during rehabilitation and 80% to engage in and make decisions about their own care. There was no difference in patient-reported QI adherence between those who accessed the toolkit and those who did not (p=0.55). Seven of 14 (50%) of clinicians accessed the QUICK toolkit during maintenance phase. Based on Google analytics, the QUICK toolkit landing page was accessed 237 times and clinicians reported they most often used the QI checklists and QUICK guides (both 86%). Of the clinicians with recent toolkit use, 86% agreed it increased their knowledge of the TJR rehabilitation evidence and 43% said it helped to identify care gaps and areas for improvement. There was no difference in clinicians with improved QI adherence comparing those who accessed the toolkit in previous 3 months and those who did not (p=0.58). Figure 1 Conclusion Only a small proportion of patients and clinicians accessed the toolkits and total views, and active users markedly declined during the maintenance phase. We will need to further explore facilitators and barriers to access and develop targeted strategies to improve uptake of the THR/TKR rehabilitation QIs. References [1.] Westby MD. Osteoarthritis Cartilage 2018;26:370-82