Use, Refine, Repeat: Implementation of a mobile application for patient education

Objectives: To identify how implementation strategies impact adoption of a patient education application by orthopaedic trauma providers and patients.   Design: Unstructured narrative interview and retrospective review   Setting: Four Level 1 Trauma Centers   Participants: Seven researchers responsible for enrolling orthopaedic trauma patients   Intervention: Development and implementation of a mobile application (app) (http://bit.ly/traumaapp) for patient education regarding orthopaedic trauma at three hospital sites.   Main outcome measurements: Unstructured narrative interviews were gathered from seven investigators (attendings n = 3, research personnel n = 4). Standard usage statistics were obtained from the google play and apple app stores including active users, time in app, user download geographic region. Download ratios were calculated from investigator logs of approaches and success.   Results: In the 39 months between January 2017 to April 2020, there were 144 downloads by patients at the original center. In the three other centers added in October 2018, there were 404, 109, and 34 downloads over an 18-month period until April 2020. The mean number of downloads per center was 173±161. Quotes from unstructured narrative interviews by investigators described promotional materials as “effective” and the app as “easy to use” with “relevant content.” Additionally, all investigators reported that patients were able to find the app easily and that a majority of patients had devices capable of using the app. Four investigators report that they believe intentional provider interaction with the patient and app increased the download ratio, which ranged from 0.7% to 9.8% of all trauma admissions at each center. Active champions were referenced by all investigators as leading to increased downloads regardless of provider level of the champion. All centers struggled to influence providers beyond the study investigators to adopt the app. All investigators reported poor cell reception and problems with internet connection in hospitals as barriers to facilitating patient downloads.   Conclusion: This study documents the successes and challenges of implementing patient education app for orthopaedic trauma patients presenting to four Level 1 trauma centers in the US and UK. At our institutions, downloads were driven by organizational champions at each center who actively promoted the app to patients using standard promotional materials. However, organizational challenges and unreceptive healthcare workers remain a challenge and adoption was not widespread among non-participant providers at each institution. Ultimately, our experience identified iteratively improving implementation strategies and empowering an organizational champion who can lead iterations of implementation, improve relevant technology, and prepare the organization for app adoption as strategies critical to our success.   Level of Evidence: IV Keywords: Patient education, technology, mobile application, app, trauma, orthopaedic, champion, iteration, multicenter (J Ortho Business 2022; Volume 2, Issue 3:pages 12-17)