Enhancing Trauma Patient Experience Through Education and Engagement: Development of a Mobile Application.

The purpose was to determine the utility of an open access mobile device application (App: http://bit.ly/traumaapp) to improve patient education and engagement. Methods: A patient education app was developed with information regarding injury, treatment, and recovery for orthopaedic and other injuries. Data regarding usage, satisfaction, and desired improvements were gathered. Results: The app was downloaded 725 times, and the pages in the app were viewed 9,043 times in 34 months. User sessions >2 minutes accounted for 34%. Participation was less in those older than 55 years (12% versus 68% P < 0.001). Sixteen percent of patients did not have a device to use the app. Most (55%) rated it as helpful or extremely helpful; 78% of users were likely to recommend it. Patients most frequently suggested more information on other injuries and simpler language. Discussion: There was strong interest in this simple, free patient education app. Despite an urban, trauma population, five of six patients had access to a device that could load the app. Nearly half of the patients downloaded an orthopaedic patient education app when offered. Those who did not use the app were more likely to be older than 55 years. This represents an innovative opportunity for education and engagement of our patients and their families.

Treatment of Hypovitaminosis D in an Orthopaedic Trauma Population.

OBJECTIVES: To determine the incidence of hypovitaminosis D and to evaluate a supplementation intervention. We hypothesized that patients would exhibit high adherence with a free sample, and levels would become sufficient. DESIGN: Prospective observational study. SETTING: Level 1 trauma center. PATIENTS: One hundred forty-four consecutive, skeletally mature patients treated for acute fractures. INTERVENTION: All were provided 600 mg calcium and 800 IU vitamin D3 capsules twice daily. MAIN OUTCOME MEASUREMENTS: Serum 25(OH) D levels were obtained on presentation and after supplementation. Patient surveys determined adherence, vitamin D intake, and sun exposure. RESULTS: Ninety-one men and 53 women, mean age 45 years, mean body mass index 28.1, were studied. Mean baseline 25(OH) D level was 20.2 ng/mL, including 9 patients taking vitamin D supplements before injury. All others (mean baseline 16.9 ng/mL) were prescribed calcium and vitamin D and were offered free supplements when discharged. Seventy-seven patients completed surveys, and mean 25(OH) D level was 36.7 ng/mL after a mean of 7.0 weeks of supplementation (P < 0.0001). Seventy-nine percent reported adherence to supplement recommendations. All adherent patients achieved normal levels. Sixteen patients were nonadherent, with 10 who forgot to take the supplement, 4 choosing not to use it, 1 choosing to sell the sample, and 1 losing the sample. CONCLUSION: Hypovitaminosis D was present in 97% of orthopaedic trauma patients who were not already taking supplements. The intervention was effective in reducing hypovitaminosis D within several weeks, with all supplemented patients achieving normal levels. Seventy-nine percent of patients adhered to recommendations. Further study to determine the long-term cost-effectiveness of this strategy seems warranted. LEVEL OF EVIDENCE: Therapeutic, Level II. See Instructions for Authors for a complete description of levels of evidence.

Economic Benefit of Calcium and Vitamin D Supplementation: Does It Outweigh the Cost of Nonunions?

OBJECTIVES: The purpose was to evaluate economic benefit of calcium and vitamin D supplementation in orthopaedic trauma patients. We hypothesized that reduced nonunion rates could justify the cost of supplementing every orthopaedic trauma patient. DESIGN: Retrospective, economic model. SETTING: Level 1 trauma center. PATIENTS/PARTICIPANTS: Adult patients over 3 consecutive years presenting with acute fracture. INTERVENTION: Operative or nonoperative fracture management. MAIN OUTCOME MEASUREMENTS: Electronic medical records were queried for ICD-9 code for diagnosis of nonunion and for treatment records of nonunion for fractures initially treated within our institution. RESULTS: In our hospital, a mean of 92 (3.9%) fractures develop nonunion annually. A 5% reduction in nonunion risk from 8 weeks of vitamin D supplementation would result in 4.6 fewer nonunions per year. The mean estimate of cost for nonunion care is $16,941. Thus, the projected reduction in nonunions after supplementation with vitamin D and calcium would save $78,030 in treatment costs per year. The resulting savings outweigh the $12,164 cost of supplementing all fracture patients during the first 8 weeks of fracture healing resulting in a net savings of $65,866 per year. CONCLUSIONS: Vitamin D and calcium supplementation of orthopaedic trauma patients for 8 weeks after fracture seems to be cost effective. Supplementation may also reduce the number of subsequent fractures, enhance muscular strength, improve balance in the elderly, elevate mood leading to higher functional outcome scores, and diminish hospital tort liability by reducing the number of nonunions. LEVEL OF EVIDENCE: Economic Level V. See Instructions for Authors for a complete description of levels of evidence.