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- Dahlberg, Karuna, 1979-, et al.
(författare)
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Cost-effectiveness of a systematic e-assessed follow-up of postoperative recovery after day surgery : a multicentre randomized trial
- 2017
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Ingår i: British Journal of Anaesthesia. - : Oxford University Press. - 0007-0912 .- 1471-6771. ; 119:5, s. 1039-1046
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Tidskriftsartikel (refereegranskat)abstract
- Background: Most surgeries are done on a day-stay basis. Recovery assessment by phone points (RAPP) is a smartphonebased application (app) to evaluate patients after day surgery. The aim of this study was to estimate the cost-effectiveness of using RAPP for follow-up on postoperative recovery compared with standard care.Methods: This study was a prospective parallel single-blind multicentre randomized controlled trial. Participants were randomly allocated to the intervention group using RAPP or the control group receiving standard care. A cost-effectiveness analysis was performed based on individual data and included costs for the intervention, health effect [quality-adjusted life-years (QALYs)], and costs or savings in health-care use.Results: The mean cost for health-care consumption during 2 weeks after surgery was estimated at e37.29 for the intervention group and e60.96 for the control group. The mean difference was e23.66 (99% confidence interval 46.57 to0.76; P¼0.008). When including the costs of the intervention, the cost-effectiveness analysis showed net savings of e4.77 per patient in favour of the intervention. No difference in QALYs gained was seen between the groups (P¼0.75). The probability of the intervention being cost-effective was 71%.Conclusions: This study shows that RAPP can be cost-effective but had no effect on QALY. RAPP can be a cost-effective toolin providing low-cost health-care contacts and in systematically assessing the quality of postoperative recovery.Clinical trial registration:NCT02492191
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| 3. |
- Hälleberg Nyman, Maria, 1968-, et al.
(författare)
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Association Between Functional Health Literacy and Postoperative Recovery, Health Care Contacts, and Health-Related Quality of Life Among Patients Undergoing Day Surgery Secondary Analysis of a Randomized Clinical Trial
- 2018
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Ingår i: JAMA Surgery. - : American Medical Association. - 2168-6254 .- 2168-6262. ; 153:8, s. 738-745
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Tidskriftsartikel (refereegranskat)abstract
- Importance: Day surgery puts demands on the patients to manage their own recovery at home according to given instructions. Low health literacy levels are shown to be associated with poorer health outcomes.Objective: To describe functional health literacy levels among patients in Sweden undergoing day surgery and to describe the association between functional health literacy (FHL) and health care contacts, quality of recovery (SwQoR), and health-related quality of life.Design, Setting, and Participants: This observational study was part of a secondary analysis of a randomized clinical trial of patients undergoing day surgery and was performed in multiple centers from October 2015 to July 2016 and included 704 patients.Main Outcomes and Measures: The primary end point was SwQoR in the FHL groups 14 days after surgery. Secondary end points were health care contacts, EuroQol-visual analog scales, and the Short Form (36) Health Survey in the FHL groups.Results: Of 704 patients (418 [59.4%] women; mean [SD] age with inadequate or problematic FHL levels, 47 [16] years and 49 [15.1], respectively), 427 (60.7%) reported sufficient FHL, 223 (31.7%) problematic FHL, and 54 (7.7%) inadequate FHL. The global score of SwQoR indicated poor recovery in both inadequate (37.4) and problematic (22.9) FHL. There was a statistically significant difference in the global score of SwQoR (SD) between inadequate (37.4 [34.7]) and sufficient FHL (17.7 [21.0]) (P < .001). The patients with inadequate or problematic FHL had a lower health-related quality of life than the patients with sufficient FHL in terms of EuroQol-visual analog scale scores (mean [SD], 73 [19.1], 73 [19.1], and 78 [17.4], respectively; P = .008), physical function (mean [SD], 72 [22.7], 75 [23.8], and 81 [21.9], respectively; P < .001), bodily pain (mean [SD], 51 [28.7], 53 [27.4], and 61 [27.0], respectively; P = .001), vitality (mean [SD], 50 [26.7], 56 [23.5], and 62 [25.4], respectively; P < .001), social functioning (mean [SD], 73 [28.2], 81 [21.8], and 84 [23.3], respectively; P = .004), mental health (mean [SD], 65 [25.4], 73 [21.2], and 77 [21.2], respectively; P < .001), and physical component summary (mean [SD], 41 [11.2], 42 [11.3], and 45 [10.1], respectively; P = .004). There were no differences between the FHL groups regarding health care contacts.Conclusions and Relevance: Inadequate FHL in patients undergoing day surgery was associated with poorer postoperative recovery and a lower health-related quality of life. Health literacy is a relevant factor to consider for optimizing the postoperative recovery in patients undergoing day surgery.
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| 4. |
- Dahlberg, Karuna, 1979-
(författare)
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e-Assessed follow-up of postoperative recovery : developement, evaluation and patient experiences
- 2018
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The majority of all surgeries are performed as day surgery. After discharge, patients are expected to take responsibility for their postoperative recovery themselves. Recovery Assessment by Phone Points (RAPP) is an e-assessment developed for assessing and providing follow-up on postoperative recovery, which includes the Swedish web-version of the Quality of Recovery questionnaire (SwQoR). It also enables the patient to get in contact with the day surgery unit. The overall aim of this thesis was to further develop and evaluate a systematic follow-up of postoperative recovery using a mobile app in adult persons undergoing day surgery, as well as to describe their experiences of postoperative recovery when using the mobile app. Study I: This study included three steps. Equivalence testing between the paper and app versions of the SwQoR showed agreement (n=69). The feasibility and acceptability evaluation showed that participants (n=63) were positive towards using a mobile phone application during postoperative recovery. Content validity of the SwQoR reduced the original 31 items to 24. Studies II and III: A multicentre, two-group, parallel, single-blind randomized controlled trial including 997 participants was conducted to investigate the effect of e-assessment on postoperative recovery (II) and cost-effectiveness (III) in a RAPP group compared with a control group. The RAPP group reported significantly better quality of postoperative recovery on postoperative days 7 and 14 compared with the control group. Moreover, RAPP may be cost-effective as it provides low-cost care. Study IV: Explored experience of postoperative recovery in participants using a mobile phone app during their postoperative recovery. Qualitative inductive semi-structured interviews (n=18) were performed. Findings showed that feeling safe is important during postoperative recovery. This feeling can be created by patients themselves, but sufficient support and information from health care and next of kin is needed. Overall, this thesis showed positive results for RAPP, suggesting that RAPP is a solution that may benefit patients after day surgery.
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| 5. |
- Dahlberg, Karuna, 1979-, et al.
(författare)
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Evaluation of the Swedish Web-Version of Quality of Recovery (SwQoR) : Secondary Step in the Development of a Mobile Phone App to Measure Postoperative Recovery
- 2016
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Ingår i: JMIR Research Protocols. - Toronto, Canada : JMIR Publications, Inc. - 1929-0748. ; 5:3
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Tidskriftsartikel (refereegranskat)abstract
- Background: The majority of all surgeries are performed on an outpatient basis (day surgery). The Recovery Assessment by Phone Points (RAPP) app is an app for the Swedish Web-version of Quality of Recovery (SwQoR), developed to assess and follow-up on postoperative recovery after day surgery.Objectives: The objectives of this study are (1) to estimate the extent to which the paper and app versions of the SwQoR provide equivalent values; (2) to contribute evidence as to the feasibility and acceptability of a mobile phone Web-based app for measuring postoperative recovery after day surgery and enabling contact with a nurse; and (3) to contribute evidence as to the content validity of the SwQoR.Methods: Equivalence between the paper and app versions of the SwQoR was measured using a randomized crossover design, in which participants used both the paper and app version. Feasibility and acceptability was evaluated by a questionnaire containing 16 questions regarding the value of the app for follow-up care after day surgery. Content validity evaluation was based on responses by day surgery patients and the staff of the day surgery department.Results: A total of 69 participants completed the evaluation of equivalence between the paper and app versions of the SwQoR. The intraclass correlation coefficient (ICC) for the SwQoR was .89 (95% CI 0.83-0.93) and .13 to .90 for the items. Of the participants, 63 continued testing the app after discharge and completed the follow-up questionnaire. The median score was 69 (inter-quartile range, IQR 66-73), indicating a positive attitude toward using an app for follow-up after day surgery. A total of 18 patients and 12 staff members participated in the content validity evaluation. The item-level content validity index (I-CVI) for the staff group was in the 0.64 to 1.0 range, with a scale-level content validity index (S-CVI) of 0.88. For the patient group, I-CVI was in the range 0.30 to 0.92 and S-CVI was 0.67. The content validity evaluation of the SwQoR, together with three new items, led to a reduction from 34 to 24 items.Conclusions: Day surgery patients had positive attitudes toward using the app for follow-up after surgery, and stated a preference for using the app again if they were admitted for a future day surgery procedure. Equivalence between the app and paper version of the SwQoR was found, but at the item level, the ICC was less than .7 for 9 items. In the content validity evaluation of the SwQoR, staff found more items relevant than the patients, and no items found relevant by either staff or patients were excluded when revising the SwQoR.
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| 7. |
- Dahlberg, Karuna, 1979-, et al.
(författare)
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Holding It Together - Patients' Perspectives on Postoperative Recovery When Using an e-Assessed Follow-Up : Qualitative Study
- 2018
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Ingår i: JMIR mhealth and uhealth. - : JMIR Publications Inc.. - 2291-5222. ; 20:5
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Tidskriftsartikel (refereegranskat)abstract
- Background: There is an emerging trend to perform surgeries as day surgery. After a day surgery, most of the recovery period takes place at home, and patients are responsible for their own recovery. It has been suggested that electronic health (eHealth) technologies can support patients in this process. A mobile app has recently been developed to assess and follow up on postoperative recovery after a day surgery.Objective: The aim of this study was to explore experiences associated with postoperative recovery after a day surgery in patients using a mobile app to assess the quality of their recovery.Methods: This is a qualitative interview study with an explorative and descriptive design. Participants were recruited from 4 different day surgery units in different parts of Sweden. The study included 18 participants aged >17 years who had undergone day surgery and used the Recovery Assessment by Phone Points, a mobile app for follow-up on postoperative recovery after day surgery. Participants were purposively selected to ensure maximum variation. Semistructured individual interviews were conducted. Data were analyzed using thematic analysis.Results: A total of two themes and six subthemes emerged from the data: (1) the theme Give it all you’ve got with the subthemes Believing in own capacity, Being prepared, and Taking action, where participants described their possibilities of participating and themselves contributing to improving their postoperative recovery; and (2) the theme The importance of feeling safe and sound with the subthemes Feeling safe and reassured, Not being acknowledged, and Not being left alone, which describe the importance of support from health care professionals and next of kin. Conclusions: It is important that patients feel safe, reassured, and acknowledged during their postoperative recovery. They can achieve this themselves with sufficient support and information from the health care organization and their next of kin. Using a mobile app, both for assessment and to enable contact with the day surgery unit during the postoperative recovery period, can improve care and create a feeling of not being alone after surgery. We propose that postoperative recovery starts in the prerecovery phase when patients prepare for their recovery to get the best possible outcome from their surgery.
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| 8. |
- Dahlberg, Karuna, 1979-, et al.
(författare)
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“Let the patient decide” – person-centered postoperative follow-up contacts, initiated via a phone app after day surgery : secondary analysis of a randomized controlled trial
- 2019
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Ingår i: International Journal of Surgery. - : Elsevier. - 1743-9191 .- 1743-9159. ; , s. 33-37
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Patients undergoing day surgery are expected to manage their recovery on their own. Follow-up routines differ, but many patients have expressed a need for more professional support during recovery. The aim of this study was to describe how many follow-up contacts were initiated, and when and why, via a digital solution. Also, we wanted to compare postoperative recovery and characteristics between patients requesting, and patients not requesting, contact.MATERIALS AND METHODS: This was a secondary analysis of a multicenter, two-group, parallel randomized controlled trial. Participants used a digital solution called "Recovery Assessment by Phone Points (RAPP)" for initiating follow-up contacts after day surgery. The quality of postoperative recovery was measured with the Swedish web-version of Quality of Recovery.RESULTS: Of 494 patients, 84 (17%) initiated contact via RAPP. The most common reasons for initiating contact were related to the surgical wound and pain. Contacts were initiated across the 14-day assessment period, with 62% (62/100) in the first postoperative week. The RAPP contact group had significantly poorer postoperative recovery on days 1-14 compared to those not requesting contact via RAPP (p < 0.001). There was a significantly higher proportion of patients who had undergone general anesthesia in the RAPP contact group (85% [71/84]) compared to the non-RAPP contact group (71% [291/410]), p = 0.003.CONCLUSION: Letting the patient decide him/herself whether, and when, contact and support is needed during the postoperative period, is possible and does not increase the frequency of contacts. This study investigates a digital solution, RAPP, as one example of a person-centered approach that can be implemented in day surgery follow-up.
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| 9. |
- Dahlberg, Karuna, 1979-, et al.
(författare)
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Nurse competence and care in the postanesthesia care unit (PACU) : Nurse’s and patient’s perspectives
- 2023
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Konferensbidrag (refereegranskat)abstract
- Introduction: To create a safe PACU care, nurses need to have specific competence. There are few studies investigating PACU care from the nurse’s perspective and there is limited knowledge about patients’ experiences of early recovery and PACU care. Therefore, the aim was to describe PACU care and early recovery from the nurse’s and the patient’s perspectives.Method:Data was collected in two qualitative studies. Participants were recruited from two hospitals located in different parts of Sweden. Nurses were eligible if >1 year of experience from PACU care. Patients were eligible if the expected PACU stay was >2 hours. Semi structured individual interviews were carried out. In total 16 nurses and 14 patients were interviewed. Data were analysed using thematic analysis (1).Result: Nurse’s perspectives Nurses described PACU care competence as being adaptable in an ever-changing environment and creating safe care. That included being independent, working jointly in the team, and to prioritize and make clinical decisions. To create a safe care possessing specific knowledge, acknowledging and reassuring the patient, and to work proactively were important factors (2).Patient’s perspectives Patients described being in a transition between surgery and ward . That was captured in the subthemes Being in-between points of care, Being in PACU surroundings, Being individually acknowledged, Feeling trust in the caring provided, Feeling dehumanized and abandoned (3).
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