The clinical outcomes of a hybrid-virtual infant hip clinic for the nonoperative treatment of developmental dysplasia of the hip : a quality improvement study.

Abstract

Aims: Nonoperative treatment for developmental dysplasia of the hip (DDH) typically involves numerous in-person clinic visits, which can place a significant burden on healthcare services and patients' families. We therefore aimed to establish and validate a pilot hybrid-virtual clinic to evaluate the clinical outcomes with the delivery of a comprehensive nonoperative treatment protocol for infant DDH to streamline care and minimize in-person visits.

Methods: This was a prospective, single-centre, quality improvement (QI) study of infants with DDH who underwent a comprehensive nonoperative treatment protocol in a unified multidisciplinary infant hip clinic from December 2022 to October 2023. Practice changes were made to our published nonoperative treatment protocol, where specific in-person follow-up visits were replaced with virtual appointments, and a dedicated institutional infant hip clinic email was created for caregiver inquiries.

Results: Of all interim follow-up visits, 53% (77/144) occurred virtually; 94% (48/51) of infants successfully completed brace treatment. No failures of treatment occurred during the virtual follow-up period. In total, 8% (4/51) of infants experienced brace-related complications, including only one during the virtual phase; 10% (5/51) of infants made unplanned visits to the hip clinic, including two infants who attended for brace check and adjustments during the virtual phase. One unplanned ultrasound examination occurred during the virtual phase upon request of a caregiver, which did not alter the course of treatment. No infants required bracing for an extended time due to virtual visits. Overall, 92% (47/51) of caregivers reported awareness of the hip clinic email and 33% (17/51) used this resource. No urgent inquiries were received during the virtual phase.

Conclusion: Our hybrid-virtual infant hip clinic has shown comparable outcomes to the historic norms of our in-person infant hip clinic. This model of care can improve the efficiency of standardized DDH treatment protocols while maintaining excellent clinical outcomes.