Effectiveness of an internet-based perioperative care programme to enhance postoperative recovery in gynaecological patients: Cluster controlled trial with randomised stepped-wedge implementation

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Abstract

Objective To evaluate the implementation and effectiveness of an internet-based perioperative care programme for patients following gynaecological surgery for benign disease. Design Stepped-wedge cluster randomised controlled trial. Setting Secondary care, nine hospitals in the Netherlands, 2011-2014. Participants 433 employed women aged 18-65 years scheduled for hysterectomy and/or laparoscopic adnexal surgery. Interventions An internet-based care programme was sequentially rolled out using a multifaceted implementation strategy. Depending on the implementation phase of their hospital, patients were allocated to usual care (n=206) or the care programme (n=227). The care programme included an e-health intervention equipping patients with tailored personalised convalescence advice. Main outcome measures The primary outcome was duration until full sustainable return to work (RTW). The degree of implementation of the care programme was evaluated at the level of the patient, healthcare provider and organisation by indicators measuring internet-based actions by patients and providers. Results Median time until RTW was 49 days (IQR 27-76) in the intervention group and 62 days (42-85) in the control group. A piecewise Cox model was fitted to take into account non-proportionality of hazards. In the first 85 days after surgery, patients receiving the intervention returned to work faster than patients in the control group (HR 2.66, 95% CI 1.88 to 3.77), but this effect was reversed in the small group of patients that did not reach RTW within this period (0.28, 0.17 to 0.46). Indicators showed that the implementation of the care programme was most successful at the level of the patient (82.8%) and professional (81.7%). Conclusions Implementation of an internet-based care programme has a large potential to lead to accelerated recovery and improved RTW rates following different types of gynaecological surgeries. Trial registration number NTR2933; Results.

Original languageEnglish
Article numbere017781
JournalBMJ Open
Volume8
Issue number1
DOIs
Publication statusPublished - 1 Jan 2018

Cite this

@article{168068ffd57d4373b8149c1a37e23d28,
title = "Effectiveness of an internet-based perioperative care programme to enhance postoperative recovery in gynaecological patients: Cluster controlled trial with randomised stepped-wedge implementation",
abstract = "Objective To evaluate the implementation and effectiveness of an internet-based perioperative care programme for patients following gynaecological surgery for benign disease. Design Stepped-wedge cluster randomised controlled trial. Setting Secondary care, nine hospitals in the Netherlands, 2011-2014. Participants 433 employed women aged 18-65 years scheduled for hysterectomy and/or laparoscopic adnexal surgery. Interventions An internet-based care programme was sequentially rolled out using a multifaceted implementation strategy. Depending on the implementation phase of their hospital, patients were allocated to usual care (n=206) or the care programme (n=227). The care programme included an e-health intervention equipping patients with tailored personalised convalescence advice. Main outcome measures The primary outcome was duration until full sustainable return to work (RTW). The degree of implementation of the care programme was evaluated at the level of the patient, healthcare provider and organisation by indicators measuring internet-based actions by patients and providers. Results Median time until RTW was 49 days (IQR 27-76) in the intervention group and 62 days (42-85) in the control group. A piecewise Cox model was fitted to take into account non-proportionality of hazards. In the first 85 days after surgery, patients receiving the intervention returned to work faster than patients in the control group (HR 2.66, 95{\%} CI 1.88 to 3.77), but this effect was reversed in the small group of patients that did not reach RTW within this period (0.28, 0.17 to 0.46). Indicators showed that the implementation of the care programme was most successful at the level of the patient (82.8{\%}) and professional (81.7{\%}). Conclusions Implementation of an internet-based care programme has a large potential to lead to accelerated recovery and improved RTW rates following different types of gynaecological surgeries. Trial registration number NTR2933; Results.",
keywords = "minimally invasive surgery, organisation of health services, quality in healthcare, telemedicine",
author = "Bouwsma, {Esther V.A.} and Huirne, {Judith A.F.} and {Van De Ven}, {Peter M.} and {Vonk Noordegraaf}, Antonie and Schaafsma, {Frederieke G.} and {Schraffordt Koops}, {Steven E.} and {Van Kesteren}, {Paul J.M.} and Br{\"o}lmann, {Hans A.M.} and Anema, {Johannes R.}",
year = "2018",
month = "1",
day = "1",
doi = "10.1136/bmjopen-2017-017781",
language = "English",
volume = "8",
journal = "BMJ Open",
issn = "2044-6055",
publisher = "BMJ Publishing Group",
number = "1",

}

TY - JOUR

T1 - Effectiveness of an internet-based perioperative care programme to enhance postoperative recovery in gynaecological patients

T2 - Cluster controlled trial with randomised stepped-wedge implementation

AU - Bouwsma, Esther V.A.

AU - Huirne, Judith A.F.

AU - Van De Ven, Peter M.

AU - Vonk Noordegraaf, Antonie

AU - Schaafsma, Frederieke G.

AU - Schraffordt Koops, Steven E.

AU - Van Kesteren, Paul J.M.

AU - Brölmann, Hans A.M.

AU - Anema, Johannes R.

PY - 2018/1/1

Y1 - 2018/1/1

N2 - Objective To evaluate the implementation and effectiveness of an internet-based perioperative care programme for patients following gynaecological surgery for benign disease. Design Stepped-wedge cluster randomised controlled trial. Setting Secondary care, nine hospitals in the Netherlands, 2011-2014. Participants 433 employed women aged 18-65 years scheduled for hysterectomy and/or laparoscopic adnexal surgery. Interventions An internet-based care programme was sequentially rolled out using a multifaceted implementation strategy. Depending on the implementation phase of their hospital, patients were allocated to usual care (n=206) or the care programme (n=227). The care programme included an e-health intervention equipping patients with tailored personalised convalescence advice. Main outcome measures The primary outcome was duration until full sustainable return to work (RTW). The degree of implementation of the care programme was evaluated at the level of the patient, healthcare provider and organisation by indicators measuring internet-based actions by patients and providers. Results Median time until RTW was 49 days (IQR 27-76) in the intervention group and 62 days (42-85) in the control group. A piecewise Cox model was fitted to take into account non-proportionality of hazards. In the first 85 days after surgery, patients receiving the intervention returned to work faster than patients in the control group (HR 2.66, 95% CI 1.88 to 3.77), but this effect was reversed in the small group of patients that did not reach RTW within this period (0.28, 0.17 to 0.46). Indicators showed that the implementation of the care programme was most successful at the level of the patient (82.8%) and professional (81.7%). Conclusions Implementation of an internet-based care programme has a large potential to lead to accelerated recovery and improved RTW rates following different types of gynaecological surgeries. Trial registration number NTR2933; Results.

AB - Objective To evaluate the implementation and effectiveness of an internet-based perioperative care programme for patients following gynaecological surgery for benign disease. Design Stepped-wedge cluster randomised controlled trial. Setting Secondary care, nine hospitals in the Netherlands, 2011-2014. Participants 433 employed women aged 18-65 years scheduled for hysterectomy and/or laparoscopic adnexal surgery. Interventions An internet-based care programme was sequentially rolled out using a multifaceted implementation strategy. Depending on the implementation phase of their hospital, patients were allocated to usual care (n=206) or the care programme (n=227). The care programme included an e-health intervention equipping patients with tailored personalised convalescence advice. Main outcome measures The primary outcome was duration until full sustainable return to work (RTW). The degree of implementation of the care programme was evaluated at the level of the patient, healthcare provider and organisation by indicators measuring internet-based actions by patients and providers. Results Median time until RTW was 49 days (IQR 27-76) in the intervention group and 62 days (42-85) in the control group. A piecewise Cox model was fitted to take into account non-proportionality of hazards. In the first 85 days after surgery, patients receiving the intervention returned to work faster than patients in the control group (HR 2.66, 95% CI 1.88 to 3.77), but this effect was reversed in the small group of patients that did not reach RTW within this period (0.28, 0.17 to 0.46). Indicators showed that the implementation of the care programme was most successful at the level of the patient (82.8%) and professional (81.7%). Conclusions Implementation of an internet-based care programme has a large potential to lead to accelerated recovery and improved RTW rates following different types of gynaecological surgeries. Trial registration number NTR2933; Results.

KW - minimally invasive surgery

KW - organisation of health services

KW - quality in healthcare

KW - telemedicine

UR - http://www.scopus.com/inward/record.url?scp=85052206710&partnerID=8YFLogxK

U2 - 10.1136/bmjopen-2017-017781

DO - 10.1136/bmjopen-2017-017781

M3 - Article

VL - 8

JO - BMJ Open

JF - BMJ Open

SN - 2044-6055

IS - 1

M1 - e017781

ER -