Facilitators of and barriers to reducing thirty-day readmissions and improving patient-reported outcomes after surgical aortic valve replacement: a process evaluation of the AVRre trial

Abstract

Background: The Aortic Valve Replacement Readmission (AVRre) randomized control trial tested whether a telephone intervention would reduce hospital readmissions following surgical aortic valve replacement (SAVR). The telephone support provided 30 days of continuous phone-support (hotline) and two scheduled phone-calls from the hospital after discharge. The intervention had no effect on reducing 30-day all-cause readmission rate (30-DACR) but did reduce participants' anxiety compared to a control group receiving usual care. Depression and participant-reported health state were unaffected by the intervention. To better understand these outcomes, we conducted a process evaluation of the AVRre trial to gain insight into the (1) the dose and fidelity of the intervention, (2) mechanism of impacts, and (3) contextual factors that may have influenced the outcomes. Methods: The process evaluation was informed by the Medical Research Council framework, a widely used set of guidelines for evaluating complex interventions. A mix of quantitative (questionnaire and journal records) and qualitative data (field notes, memos, registration forms, questionnaire) was prospectively collected, and retrospective interviews were conducted. We performed descriptive analyses of the quantitative data. Content analyses, assisted by NVivo, were performed to evaluate qualitative data.

The Transmogrification of Surgical Telehealth: a PRISMA Review

“…The process and results of the review are illustrated in Figure Study characteristics are shown in Table 1. Five Literature reviews were included [7][8][9][10][11], three qualitative studies [12][13][14] and 22 quantitative studies .…”

“…Results of individual studies are shown in Table 2. The literature on telehealth in surgery has confirmed that telehealth approaches are popular with patients, [7,11,12,18,26,[28][29][30][31]37] reduce costs and time required for patients to travel and attend to their healthcare [2,10,11,20] and is clinically safe [7-9, 16, 23, 27, 29-31] for the studied applications. Prior to the COVID-19 pandemic, five review studies were spread across different surgical specialties and focussed largely on outpatient assessment of new patients or replacing routine postoperative review in narrowly defined subsets of patients, selected for their suitability for remote assessment.…”

“…It is clear that when enrolment in telehealth initiatives is enshrined in a welldefined and well publicised protocol, compliance, satisfaction and safety can be ensured. [7,9,11,14,23] The addition of telephone or platform support for patients to the normal protocol has not been shown to have any significant benefit [12,19,26,[31][32][33]. However, there was no loss of clinical accuracy or satisfaction when the telehealth modality replaced what previously required travel to the clinic or hospital [14, 17, 18, 20, 22-25, 28, 30, 35].…”

“…The potential for synchronous or asynchronous clinical support may enable routine appointment protocols to be abandoned in favour of patient-centred "care on demand" models, which may result in a decrease in clinical workload for simple operations. [8,9,12,13,20,21,27,34,37] The papers examined showed a wide variation in postoperative care regime. [7,10,14,21,38] The ability to conduct an examination by video consultation relies on careful preparation of the clinical and patient.…”

“…Accuracy of video examination findings in oral surgery, orthopaedics, urology, neurosurgery and plastic surgery has mostly been measured using clinician satisfaction. [12,14,30,38] However, with improved protocols, such as published for shoulder assessment by Sprowls, [39] confidence and reliability of telehealth assessment can be assured.…”