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Digital Health Reviews (1337) mHealth in a Clinical Setting (629) Design of Processes and Workflows (109) eHealth Infrastructures (359) Teamwork (60) Clinical Communication, Electronic Consultation and Telehealth (622) Consumer & Patient Education and Shared-Decision Making (703) Email Communication, Web-Based Communication, Secure Messaging (167) Mobile Health Technology and Digital Platforms for Public Health (40)

Published on in Vol 26 (2024)

Preprints (earlier versions) of this paper are available at https://preprints.jmir.org/preprint/55753, first published .
Platform-Based Patient-Clinician Digital Health Interventions for Care Transitions: Scoping Review

Platform-Based Patient-Clinician Digital Health Interventions for Care Transitions: Scoping Review

Platform-Based Patient-Clinician Digital Health Interventions for Care Transitions: Scoping Review

Authors of this article:

Chantal Backman1 Author Orcid Image ;   Rosie Papp1 Author Orcid Image ;   Aurelie Tonjock Kolle1 Author Orcid Image ;   Steve Papp2 Author Orcid Image ;   Sarah Visintini1 Author Orcid Image ;   Ana Lúcia Schaefer Ferreira de Mello3 Author Orcid Image ;   Gabriela Marcellino de Melo Lanzoni3 Author Orcid Image ;   Anne Harley4 Author Orcid Image
Article Authors Cited by Tweetations Metrics

    Review

    1University of Ottawa, Ottawa, ON, Canada

    2The Ottawa Hospital, Ottawa, ON, Canada

    3Universidade Federal de Santa Catarina, Florianópolis, Brazil

    4Bruyère Continuing Care, Ottawa, ON, Canada

    *these authors contributed equally

    Corresponding Author:

    Chantal Backman, RN, MHA, PhD

    University of Ottawa

    200 Lees Ave

    Ottawa, ON, K1N 6N5

    Canada

    Phone: 1 6133240838

    Email: chantal.backman@uottawa.ca


    Background: Care transitions are complex and can make patients vulnerable to adverse events. Poor communication among clinicians, patients, and their caregivers is a critical gap during these periods of transition. Technology solutions such as platform-based patient-clinician digital health interventions (DHIs) can provide support and education to patients.

    Objective: The aims of this scoping review were to explore the literature on platform-based patient-clinician DHIs specific to hospital-to-home care transitions and identify the barriers to and enablers of the uptake and implementation of these DHIs.

    Methods: A scoping review was conducted. A total of 4 databases (MEDLINE, CINAHL, Embase, and the Cochrane Central Register of Controlled Trials) were searched on July 13, 2022. Studies involving patients aged >18 years who used platform-based DHIs during their hospital-to-home transition were included. In total, 2 reviewers independently screened the articles for eligibility using a 2-stage process of title and abstract and full-text screening. Eligible studies underwent data extraction, and the results were analyzed using descriptive and narrative methods.

    Results: We screened 8322 articles, of which 97 (1.17%) met our inclusion criteria. DHIs were implemented using a mobile app (59/97, 61%), a web-based platform (28/97, 29%), or a combination of both (10/97, 10%). The 2 most common health conditions related to the DHIs were cardiac disease (22/97, 23%) and stroke (11/97, 11%). Outcomes varied greatly but were grouped by health care use, complications, and wellness outcomes. The top 2 barriers were lack of interest (13/97, 13%) and time constraints to use the DHIs (10/97, 10%), and the top 2 enablers were the ability to use the DHIs (17/97, 18%) and their ease of use (11/97, 11%). The main conflicting theme was access (enabler; 28/97, 29%) or limited access (barrier; 15/97, 15%) to technology or the internet.

    Conclusions: Platform-based DHIs could help improve communication, coordination, and information sharing between clinicians and patients during transition periods. Further research is needed to assess the effectiveness of these platform-based DHIs on patient outcomes.

    J Med Internet Res 2024;26:e55753

    doi:10.2196/55753

    Keywords

    platform based; patient-clinician; digital health intervention; care transition; mobile phone 


    Care transitions occur when a patient moves from one health care setting to another, such as from hospital to home. Effective care transitions are critical for ensuring that patients receive safe, high-quality care and for reducing the risk of adverse events, such as medication errors or unnecessary hospital readmissions [1]. However, care transitions are often complex and often involve multiple health care providers. In addition, recently hospitalized patients typically experience a temporary period of generalized risk of a wide range of adverse health events, also called “posthospital syndrome” [2]. Consequently, care transitions can be a significant source of errors, delays, and gaps in care [3,4]. One critical gap that has been identified is poor communication among clinicians, patients, and their caregivers [5,6], which is the one aspect that we hypothesize can be addressed through better technology solutions.

    Technological solutions that can help improve the transition of patients between different care settings or health care providers are often referred to as “platform-based patient-clinician digital health interventions (DHIs).” These interventions can be used to address challenges during care transitions by leveraging technology to improve communication, coordination, and information sharing between clinicians and patients. These interventions can include but are not limited to providing patients with (1) personalized care plans, reminders, and educational resources to support self-management during transitions [7]; (2) remote monitoring to help health care providers track patient vital signs and symptoms to detect early warning signs of complications [8]; and (3) exchange and communication of information between clinicians and patients [9].

    Previous research has identified 10 key elements in an ideal care transition [10]. The key domains of the Ideal Transition of Care framework [10] comprise (1) discharge planning; (2) complete communication of information; (3) availability, timeliness, clarity, and organization of information; (4) medication safety; (5) patient education to promote self-management; (6) social and community supports; (7) advanced care planning; (8) coordination of care among team members; (9) symptom monitoring and management after discharge; and (10) outpatient follow-ups. This framework was created to establish the necessary considerations pertaining to safe transitions in care. Ideally, any DHIs being developed would consider these proposed domains.

    Platform-based patient-clinician DHIs can also facilitate continuity of care. Continuity of care is an important aspect that is present when a patient experiences coherent and linked care over time or when discrete elements of care that endure over time are maintained and supported [11]. Although continuity of care can be interpreted differently between care providers, there are 3 types that are agreed upon. The first type is “informational continuity,” which refers to the use of data from previous events in a patient’s medical history to inform the appropriate care of the patient’s current encounter [11]. The second type is “management continuity,” which occurs when care from multiple health care providers is linked in a coherent manner [11]. The third type is “relational continuity,” which acknowledges the importance of the relationship between patients and providers [11].

    In addition, platform-based patient-clinician DHIs for care transitions have the potential to encourage individual behavior change and reduce health care costs [12]. It is important to ensure that these interventions are evidence based, user-friendly, and aligned with patient preferences and needs. There are limited reviews on DHIs for discharge and transitional care use, and these reviews focus mainly on a specific health aspect or condition, such as self-care associated with surgery [9] or postsurgery care for patients with hip fracture [13]. One other review identified specific health care provider roles and functions related to the use of DHIs [14]. Given that patients often have multiple health conditions, there are, to our knowledge, no reviews to date examining the use of DHIs during care transitions across various conditions to reduce siloed care. The aims of this scoping review were to explore the literature on platform-based patient-clinician DHIs specific to hospital-to-home care transitions and identify the barriers to and enablers of the uptake and implementation of these platform-based patient-clinician DHIs.


    Design

    We conducted a scoping review based on the work by Arksey and O’Malley [15], Levac et al [16], and the Joanna Briggs Institute scoping review methodologies [17]. The study is reported according to the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) checklist [18] (Multimedia Appendix 1). The methods involved five steps: (1) identifying the research question; (2) identifying relevant studies; (3) selecting the studies; (4) charting the data; and (5) collating, synthesizing, and reporting the results. The detailed protocol has been published previously [19].

    Search

    A peer-reviewed search [20] was conducted on July 13, 2022, in MEDLINE, CINAHL, Embase, and the Cochrane Central Register of Controlled Trials (Multimedia Appendix 2). The main search concepts comprised terms related to “hospital to home transition,” “patient discharge,” “transitional care,” “internet-based interventions,” “mobile applications,” “mhealth,” and “digital health” platforms and were informed by previously conducted systematic searches [14,21,22]. No limit to language was applied; however, the results were limited by a publication date from 2012 onward. We chose to review results from the previous 10 years, recognizing the rapid pace of technological advancements. Search results were exported to Covidence (Veritas Health Innovation), a systematic review software [23], and duplicates were removed using the platform’s duplicate identification features.

    Screening

    Studies were screened in 2 steps (title and abstract, and full text) based on the eligibility criteria (Textbox 1).

    Textbox 1. Inclusion and exclusion criteria.

    Inclusion criteria

    • Population: adult patients (aged >18 y) discharged from hospital to home
    • Concept: digital-based platforms that support a hospital-to-home transition, including web-based digital health interventions (DHIs), defined as programs that were delivered via the internet and accessed through a website link (URL) [24], and mobile apps, defined as software programs developed for smartphones [25]
    • Context: hospital-to-home transitions
    • Type of evidence: studies published after 2012 and identified as randomized controlled trials, quasi-experimental studies, pilot studies, feasibility studies, observational studies (case-control, cohort, cross-sectional, and descriptive studies), or qualitative studies

    Exclusion criteria

    • Concept: non–platform-based DHIs, including but not limited to wearable devices if the intervention was stand-alone (eg, to track activity), prosthetics, robotics, medical imaging technology (eg, x-rays and ultrasounds), interventions using only a standard telephone, machine learning, and telehealth
    • Type of evidence: studies in the design stage at the time of screening or if the platform-based patient-clinician DHIs were tailored specifically to and solely focused on mental health or cancer as these are unique clinical areas

    Data Charting

    Studies that met all the inclusion criteria were extracted using the Google Forms platform. The pilot-tested Google Form used a survey format for the extraction of the relevant information, including the following: lead author, year of publication, country, objectives, study design, participants, patient health condition, name of DHI, rationale of intervention, theory guiding the intervention, content of the intervention, elements of postcare, digital health tools, function of digital health tool, management or informational or relational continuity of care [11], who provided the intervention, number of days after discharge, number and duration of sessions, tailoring or modification, adherence or attrition, results, and barriers or enablers. To ensure a high-quality description of the interventions, the information extracted from each study was guided by the recommendations made by the 12-item Template for Intervention Description and Replication [26]. After data charting was completed, the Google Form was used to generate a Microsoft Excel spreadsheet to analyze the findings using descriptive and narrative methods.


    Overview

    A total of 12,752 records were retrieved from the search, of which 4430 (34.74%) were duplicates and 7837 (61.46%) were rejected at the abstract review stage, leaving 485 (3.8%) records selected for full-text review. A total of 34.2% (166/485) of the reports could not be retrieved as the full text was unavailable. In addition, 222 full-text articles were excluded for the following reasons: incorrect intervention (not DHIs related to care transitions; n=196, 88.3%), language other than French or English (n=15, 6.8%), incorrect study design (n=9, 4.1%), and incorrect patient population (n=2, 0.9%). The list of articles with reasons for exclusion can be found in Multimedia Appendix 3. The final review included a total of 97 studies after the assessment process was completed (Figure 1 [27]).

    ‎
    Figure 1. PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) flow diagram—digital heath interventions (DHIs) for care transitions.

    Characteristics of the Included Studies

    Of the 97 included studies [28-124], 34 (35%) were conducted in the United States [31,38,43,48,49,53,54,56,59,61-63, 67,71,73-75,78,79,87,89,90,92,93,102,104-108,111,113,116,118], 16 (16%) were conducted in Canada [30,33,36,51,52,55,57,60,70,80,81,94,96,97,100,117], 10 (10%) were conducted in China [41,50,82-85,91,109,121,122], 8 (8%) were conducted in the Netherlands [39,40,76,95,103,112,119,120], and 5 (5%) were conducted in Australia [42,66,68,101,115]. The remaining 25% (24/97) of the studies were conducted in 14 other countries [28,29,32,34,35,37,44-47,58,64,65,69,72,77,86,88,98,99,110,114,123,124]. The 2 most common health conditions relevant to the platform-based patient-clinician DHIs were cardiac disease (22/97, 23%) [29,31,36,38,49,50,58,59,65-67,72,79,83,87, 89,90,97,109,114,116,123] and stroke (11/97, 11%) [32,44,71,96,98,104,107,110,115,119,124].

    A wide variety of elements of postcare were implemented in the platform-based patient-clinician DHIs, including but not limited to detecting postoperative issues, assessing patients’ needs, improving patient understanding, rehabilitation, improving symptom management, and increasing self-care (Table 1).

    Table 1. Study characteristics.
    StudyCountryStudy designSettingParticipantsHealth conditionName of DHIaDigital health toolElements of postcare
    Agri et al [28], 2020SwitzerlandRetrospective monocentric cohort studyCommunity or home or retirement homePatients—intervention: n=43Colorectal surgery (colorectal resections, ostomy procedures, and stoma closures)MaelaMobile appEnhancing patient-provider communication; ability to identify symptoms of poor wound healing; enhancing patients’ knowledge, skills, and confidence; detecting any postoperative issues; pain control or management; wound care
    Antypas and Wangberg [29], 2014NorwayRandomized controlled trialCommunity, home, or retirement homePatients—intervention: n=7; control: n=12Cardiovascular diseaseInternet- and mobile-based tailored intervention to enhance maintenance of physical activity after cardiac rehabilitationMobile app and web appImproving physical activity
    Armstrong et al [30], 2017CanadaRandomized controlled trialCommunity, home, or retirement homePatients—intervention: n=32; control: n=33Ambulatory breast reconstruction surgeryQoCb Health Inc mobile appMobile appAbility to identify symptoms of poor wound healing; detecting any postoperative issues; improving symptom management; follow-up appointments with primary care provider; pain control or management; wound care
    Athilingam et al [31], 2017United StatesFeasibility (pilot) study; randomized controlled trialCommunity, home, or retirement homePatients—intervention: n=9; control: n=9Congestive HFcMobile app to improve self-care behaviors and quality of life for patients with HFMobile appIncreasing self-care; medication management; fostering treatment adherence; improving quality of life; enhancing HF-specific knowledge
    Avci and Gozum [32], 2018TurkeyDescriptive studyCommunity, home, or retirement homeCaregivers—intervention: n=62StrokeSupportive website for the caregivers of patients with stroke after dischargeWeb appEnhancing caregiver preparedness; enhancing caregiver knowledge and skills
    Backman et al [33], 2020CanadaFeasibility (pilot) studyCommunity, home, or retirement homePatients: n=34; caregivers: n=19; clinicians: n=37Hip fractureMyPath to HomeWeb appPromoting communication among patients, caregivers, and clinicians
    Bäcker et al [34], 2021GermanyRandomized controlled trialCommunity, home, or retirement homePatients—intervention: n=20; control: n=15Knee arthroplastyGenuSportMobile appRehabilitation (physical therapy and occupational therapy)
    Bauwens et al [35], 2022FranceCase-controlCommunity, home, or retirement homePatients—intervention: n=32; control: n=101ACLd reconstruction surgeryDoct-UpMobile appEncouraging ambulation; pain control or management; rehabilitation (physical therapy and occupational therapy)
    Ben-Ali et al [36], 2021CanadaFeasibility (pilot) studyCommunity, home, or retirement homePatients—intervention: n=1108Cardiac surgerySeamlessMDMobile appEnhancing patients’ knowledge, skills, and confidence; improving patient understanding; increasing self-care; detecting any postoperative issues; encouraging lifestyle changes; improving symptom management; pain control or management; wound care; providing PROse, surveys, and feedback
    Birkhäuser et al [37], 2020SwitzerlandProspective nonrandomized pilot clinical trialCommunity, home, or retirement homePatients—intervention: n=18Radical cystectomyCellphone-based health care appMobile app and web appMonitor progression of patient recovery
    Blewer et al [38], 2020United StatesRandomized controlled trialCommunity, home, or retirement homePatients—intervention: n=699; control: n=626Coronary artery diseasemApp CPRf training appMobile appProviding effective CPR
    Bouwsma et al [39], 2018The NetherlandsRandomized controlled trialCommunity, home, or retirement homePatients—intervention: n=227; control: n=206Hysterectomy and laparoscopic adnexal surgeryeHealth interventionWeb appAbility to identify symptoms of poor wound healing; enhancing patients’ knowledge, skills, and confidence; detecting any postoperative issues; improving symptom management; guidance in the process of resuming work activities
    Bouwsma et al [40], 2018The NetherlandsRandomized controlled trialCommunity, home, or retirement homePatients—intervention: n=227; control: n=206Hysterectomy or laparoscopic adnexal surgeryeHealth interventionWeb appEnhancing patients’ knowledge, skills, and confidence; detecting any postoperative issues; encouraging return to work
    Cheng et al [41], 2022ChinaRandomized controlled trialCommunity, home, or retirement homePatients—intervention: n=19; control: n=20Hip fractureHome-based rehabilitation mobile appMobile appEnhancing caregiver knowledge and skills; enhancing patients’ knowledge, skills, and confidence; improving physical activity; rehabilitation (physical therapy and occupational therapy); fostering treatment adherence; progress summary (can track completion of tasks), reminders, and support information
    Cox et al [42], 2015AustraliaFeasibility (pilot) studyCommunity, home, or retirement homePatients—intervention: n=10Cystic fibrosisActivOnlineWeb appImproving physical activity; encouraging lifestyle changes; improving symptom management; improving quality of life
    Davis et al [43], 2020United StatesRetrospective reviewCommunity, home, or retirement homePatients—intervention: n=47Total shoulder arthroplastyForce TherapeuticsMobile appEnhancing patient-provider communication; enhancing patients’ knowledge, skills, and confidence; rehabilitation (physical therapy and occupational therapy)
    Davoody and Hägglund [44], 2016SwedenQualitative studyCommunity, home, or retirement homeCare professionals—intervention: n=8StrokeeHealth for postdischarge strokeWeb appImprove patient understanding; rehabilitation (physical therapy and occupational therapy)
    De Batlle et al [45], 2021SpainProspective, pragmatic, 2-arm, parallel-implementation trialCommunity, home, or retirement homePatients—intervention: n=48; control: n=28Chronic obstructive pulmonary disease and HFCONNECAREMobile app and wearable deviceEnhancing patient-provider communication; monitoring pulse, oxygen, HRg, BPh, and weight at home; enhancing patients’ knowledge, skills, and confidence; improving physical activity; assessing patients’ needs
    Debono et al [46], 2016FranceFeasibility (pilot) studyCommunity, home, or retirement homePatients—intervention: n=60Ambulatory lumbar discectomyMobile app for postoperative monitoring after outpatient lumbar discectomyMobile appEnhancing patient-provider communication; assessing rates of complications; pain control or management
    Debono et al [47], 2019FranceRetrospective analysisCommunity, home, or retirement homePatients—intervention: n=1920; control: n=1563Spinal cord injury and lumbar disc herniatione-fitbackMobile appEnhancing patient-provider communication; detecting any postoperative issues; pain control or management; wound care
    Devito Dabbs et al [48], 2016United StatesRandomized controlled trialCommunity, home, or retirement homePatients—intervention: n=99; control: n=102Lung transplantPocket PATHiMobile appDetecting any postoperative issues; assessing patients’ needs; assessing rates of complications; pain control or management
    Dorsch et al [49], 2021United StatesRandomized controlled trialCommunity, home, or retirement homePatients—intervention: n=42; control: n=41HFManageHF4LifeMobile app and monitoring devicesEnhancing patients’ knowledge, skills, and confidence; increasing self-care; encouraging lifestyle changes; improving symptom management; assessing patients’ needs; medication management; nutrition support; improving quality of life
    Duan et al [50], 2018ChinaPilot randomized controlled trialCommunity, home, or retirement homePatients—intervention: n=44; control: n=39Coronary artery diseaseHealth behavior intervention for patients with coronary heart disease through the webWeb appImproving physical activity; improving food consumption
    Dukeshire et al [51], 2012CanadaFeasibility (pilot) studyCommunity, home, or retirement homePatients—intervention: n=31HysterectomySAFERj projectWeb appImproving symptom management; ability to identify symptoms; postsurgical care
    Eustache et al [52], 2023CanadaCohort studyCommunity, home, or retirement homePatients—intervention: n=94; matched cohort: n=256Colorectal surgerySame-day discharge mHealthk app (CareSense)Mobile appEnhancing patients’ knowledge, skills, and confidence; detecting any postoperative issues; enhancing patient-provider communication
    Felbaum et al [53], 2018United StatesProspective cohort studyCommunity, home, or retirement homePatients—intervention: n=56Spinal cord injury, lumbar disc herniation, and neurosurgery (spinal and cranial surgery)TrackMyRecoveryMobile appEnhancing patient-provider communication; ability to identify symptoms of poor wound healing; detecting any postoperative issues; pain control or management; wound care
    Ganapathy et al [54], 2017United StatesFeasibility (pilot) studyCommunity, home, or retirement homePatients—intervention: n=40; caregivers—intervention: n=40Cirrhosis and hepatic encephalopathyPatient BuddyMobile appEnhancing caregiver preparedness; enhancing caregiver knowledge and skills; enhancing patient-provider communication; monitoring pulse, oxygen, HR, BP, and weight at home; enhancing patients’ knowledge, skills, and confidence; detecting any postoperative issues; delirium screening and management; fall prevention; medication management; entering grams of sodium consumed; assessing cognition (EncephalApp); Timed Up and Go test
    Gollish et al [55], 2019CanadaFeasibility (pilot) study; qualitative studyCommunity, home, or retirement homePatients—intervention: n=629Total hip replacement and knee arthroplastymyHip&KneeMobile appEnhancing patient-provider communication; increasing self-care; detecting any postoperative issues; encouraging lifestyle changes; improving symptom management; medication management; pain control or management
    Gunter et al [56], 2018United StatesFeasibility (pilot) studyCommunity, home, or retirement homePatients—intervention: n=40Vascular surgeryWoundCheckMobile appAbility to identify symptoms of poor wound healing; detecting any postoperative issues; improving symptom management; wound care
    Habib et al [57], 2021CanadaRandomized controlled trialCommunity, home, or retirement homePatients—intervention: n=23; control: n=26All health conditionsSAMlMobile appMedication management; promoting adherence to medication
    Hägglund et al [58], 2015SwedenRandomized controlled trialCommunity, home, or retirement homePatients—intervention: n=32; control: n=40HFHome intervention system (OPTILOGGm)Web app and monitoring devicesEnhancing patient-provider communication; enhancing patients’ knowledge, skills, and confidence; improving patient understanding; increasing self-care; improving symptom management
    Heiney et al [59], 2020United StatesFeasibility (pilot) studyCommunity, home, or retirement homePatients—intervention: n=12HFHealthy HeartMobile appEnhancing patient-provider communication; monitoring pulse, oxygen, HR, BP, and weight at home; ability to identify symptoms of HF; enhancing patients’ knowledge, skills, and confidence; encouraging lifestyle changes; medication management; managing emotional changes; improving quality of life
    Heuser et al [60], 2021CanadaRetrospective cohort studyCommunity, home, or retirement homePatients—intervention: n=396; control: n=458Obesity and bariatric surgerySeamlessMDMobile appManaging mood and anxiety; enhancing patients’ knowledge, skills, and confidence; increasing self-care; improving physical activity; encouraging lifestyle changes; improving symptom management; medication management; nutrition support; wound care
    Heyworth et al [61], 2014United StatesFeasibility (pilot) studyCommunity, home, or retirement homePatients—intervention: n=60All health conditionsSMMRTnWeb appMedication management
    Highland et al [62], 2019United StatesFeasibility (pilot) study; randomized controlled trialCommunity, home, or retirement homePatients—intervention: n=24; control: n=26Peripheral nerve block affecting one or more of the limbsmCare systemMobile appDetecting any postoperative issues; assessing patients’ needs
    Holzer et al [63], 2022United StatesFeasibility (pilot) studyCommunity, home, or retirement home, rehabilitation, long-term care and nursing home (24-hour care)Patients—intervention: n=89; control: n=128Acute venous thromboembolismHealthFloMobile appEnhancing patient-provider communication; enhancing patients’ knowledge, skills, and confidence; medication management
    Houchen-Wolloff et al [64], 2021United KingdomFeasibility (pilot) studyCommunity, home, or retirement homePatients—intervention: n=100Chronic obstructive pulmonary diseaseSPACEo for chronic obstructive pulmonary diseaseWeb appEnhancing patient-provider communication; improving patient understanding; increasing self-care; improving physical activity
    İlaslan and Özer [65], 2022TurkeyRandomized controlled trialCommunity, home, or retirement homePatients—intervention: n=32; control: n=32Congestive HFWeb app for training and telephone follow-up for patients with HFWeb appAbility to identify symptoms of HF; improving symptom management; meeting the informational needs of patients
    Indraratna et al [66], 2022AustraliaFeasibility (pilot) study; randomized controlled trialCommunity, home, or retirement homePatients—intervention: n=81; control: n=83Cardiac diseaseTeleClinical CareMobile app and wearable deviceMonitoring pulse, oxygen, HR, BP, and weight at home
    Johnson et al [67], 2022United StatesFeasibility (pilot) studyCommunity, home, or retirement homePatients—intervention: n=16; control: n=15Decompensated HFHF-SMARTpWeb appAbility to identify symptoms of HF; enhancing patients’ knowledge, skills, and confidence; improving patient understanding; encouraging lifestyle changes; improving symptom management; improving quality of life
    Kang et al [68], 2022AustraliaFeasibility (pilot) study; randomized controlled trialCommunity, home, or retirement homePatients—intervention: n=43; control: n=42General surgeryWeb-based discharge education programWeb appIncreasing self-care
    Kargar et al [69], 2020IranRandomized controlled trialCommunity, home, or retirement homePatients—intervention: n=30; control: n=30BurnsSelf-care educational mobile app for burnsMobile app and web appImproving quality of life
    Keng et al [70], 2020CanadaCross-sectional studyCommunity, home, or retirement homePatients—intervention: n=106Colorectal surgeryHome to Stay digital program after colorectal surgeryMobile appMonitoring patient recovery at home
    Kersey et al [71], 2022United StatesFeasibility (pilot) study; randomized controlled trialCommunity, home, or retirement homePatients—intervention: n=16; control: n=15StrokemHealth platform for strategy training in inpatient stroke rehabilitation (iADAPTq)Mobile appAssessing the feasibility of inpatient stroke rehabilitation
    Khan et al [72], 2018DenmarkMixed methods studyCommunity, home, or retirement homePatients—intervention: n=33Cardiac surgeryActiveheart portalWeb appNot reported
    Khanwalkar et al [73], 2019United StatesCase-controlCommunity, home, or retirement homePatients—intervention: n=208Septosplasty and endoscopic sinus surgeryDPEr platformMobile appDetecting any postoperative issues; pain control or management; PROs; monitoring pain; collecting data on the postoperative day when the patient returned to work
    Kim et al [74], 2016United StatesFeasibility (pilot) studyCommunity, home, or retirement homePatients—intervention: n=13Knee arthroplastyiGBs programMobile appEnhancing patients’ knowledge, skills, and confidence; increasing self-care; detecting any postoperative issues; improving physical activity; encouraging lifestyle changes; rehabilitation (physical therapy and occupational therapy); improving quality of life
    Knapp et al [75], 2021United StatesQuantified patient engagementCommunity, home, or retirement homePatients—intervention: n=207Total hip replacement and knee arthroplastyPeerWellMobile app, web app, and SMS text messagingPromoting mental well-being; enhancing patients’ knowledge, skills, and confidence; improving physical activity; nutrition support; rehabilitation (physical therapy and occupational therapy); improving quality of life
    Kooij et al [76], 2021The NetherlandsFeasibility (pilot) study; mixed methods studyCommunity, home, or retirement homePatients: n=39Chronic obstructive pulmonary diseaseSelf-management app for high-risk patients with chronic obstructive pulmonary diseaseMobile appIncreasing self-care; improving symptom management; medication management
    Kristjánsdóttir et al [77], 2013NorwayRandomized controlled trialCommunity, home, or retirement homePatients—intervention: n=48; control: n=64Chronic widespread painSmartphone-based intervention for chronic widespread painMobile app and web appPromoting self-management of chronic pain
    Kummerow et al [78], 2015United StatesFeasibility (pilot) studyCommunity, home, or retirement homePatients—intervention: n=50General surgeryMHAVtWeb appEnhancing patient-provider communication; improving symptom management; assessing patients’ needs; wound care
    Layton et al [79], 2014United StatesFeasibility (pilot) studyCommunity, home, or retirement homePatients—intervention: n=16Coronary artery disease and congestive HFSmartphone-based app to monitor outpatient discharge instructions of patients with cardiac diseaseMobile appEnhancing patient-provider communication; improving patient understanding; increasing self-care; follow-up appointments with primary care provider; medication management; encouraging activity
    Lee et al [80], 2022CanadaFeasibility (pilot) studyCommunity, home, or retirement homePatients—intervention: n=70; control: n=35Colorectal surgeryMobile app follow-up for same-day dischargeMobile appDetecting any postoperative issues; pain control or management
    Lee et al [81], 2022CanadaCohort studyCommunity, home, or retirement homePatients—intervention: n=48; control: n=73Colorectal surgerymHealth remote postdischarge monitoringMobile appEnhancing patient-provider communication; improving symptom management; assessing rates of complications
    Liu et al [82], 2021ChinaRandomized controlled trialCommunity, home, or retirement homePatients—intervention: n=49; control: n=49Spinal cord injuryTogetherMobile appEnhancing patients’ knowledge, skills, and confidence; detecting any postoperative issues; follow-up appointments with primary care provider; improving quality of life
    Li et al [83], 2022ChinaRandomized controlled trialCommunity, home, or retirement homePatients—intervention: n=143; control: n=147Coronary artery diseaseDTxuMobile appMonitoring pulse, oxygen, HR, BP, and weight at home; enhancing patients’ knowledge, skills, and confidence; encouraging lifestyle changes; improving symptom management; medication management
    Lou et al [84], 2022ChinaQuasi-experimental studyCommunity, home, or retirement homePatients—intervention: n=101; control: n=60Not reportedmVSv intervention to enhance spiritual well-beingMobile appFostering spiritual well-being
    Lyu et al [85], 2021ChinaRandomized controlled trialCommunity, home, or retirement homePatients—intervention: n=58; control: n=58Diabetes (type 2)Nurse-led web-based transitional care programWeb appIncreasing self-care; fostering treatment adherence; improving quality of life
    María Gómez et al [86], 2022ColombiaRandomized controlled trialCommunity, home, or retirement homePatients—intervention: n=39; control: n=42Diabetes (type 2)mHealth app for patients with type 2 diabetesMobile app and web appManaging glycemic control
    Marvel et al [87], 2021United StatesNonrandomized controlled trialCommunity, home, or retirement homePatients—intervention: n=200; control: n=864Acute myocardial infarctionAcute myocardial infarction DHIMobile app and wearable deviceEnhancing patient-provider communication; monitoring pulse, oxygen, HR, BP, and weight at home; increasing self-care; follow-up appointments with primary care provider; medication management
    Metilda et al [88], 2021IndiaRandomized controlled trialCommunity, home, or retirement homePatients—intervention: n=50; control: n=50Brain injuryAimeoMobile appEnhancing patient-provider communication; enhancing patients’ knowledge, skills, and confidence; detect any postoperative issues
    Park et al [89], 2019United StatesFeasibility and adoptability studyCommunity, home, or retirement homePatients—intervention: n=58Congestive HFDigital health monitoring for patients with HFMobile app and web appAbility to identify symptoms of HF; increasing self-care; improving symptom management
    Paruchuri et al [90], 2021United StatesFeasibility (pilot) studyCommunity, home, or retirement homePatients—intervention: n=118; control: n=343Coronary artery diseaseWellframeMobile appEnhancing patients’ knowledge, skills, and confidence; encouraging lifestyle changes; improving symptom management; improving quality of life
    Peng et al [91], 2022ChinaRandomized controlled trialCommunity, home, or retirement homePatients—intervention: n=47; control: n=47Hepato-pancreato-biliary surgery and biliary tract diseaseMobile continuous nursing platformMobile appEnhancing caregiver knowledge and skills; enhancing patient-provider communication; ability to identify symptoms of poor wound healing; enhancing patients’ knowledge, skills, and confidence; improving caregiver understanding; detecting any postoperative issues; assessing patients’ needs; medication management; managing emotional changes; nutrition support; improving quality of life; wound care; T-tube placement and fixation method; observation of bile-related traits; treatment method of T-tube slippage; selection, fixation, or replacement of drainage bag
    Pickens et al [92], 2019United StatesFeasibility (pilot) studyCommunity, home, or retirement homePatients—intervention: n=122Hepato-pancreato-biliary surgerySeamlessMDMobile appManaging mood and anxiety; enhancing patients’ knowledge, skills, and confidence; detecting any postoperative issues; improving physical activity; improving symptom management; nutrition support; improving quality of life; collecting PROs
    Ponder et al [93], 2020United StatesDescriptive study; feasibility (pilot) studyCommunity, home, or retirement homePatients—intervention: n=47Spinal cord injurySmartphone app with a digital care pathway for patients undergoing spine surgeryMobile app and web appImproving patient engagement; facilitating shared decision-making between patients and caregivers
    Pooni et al [94], 2022CanadaRandomized controlled trialCommunity, home, or retirement homePatients—intervention: n=128; control: n=125Colorectal surgeryPostdischarge Home to Stay mobile appMobile app and web appAbility to identify symptoms of poor wound healing; improving patient understanding; detecting any postoperative issues
    Pronk et al [95], 2020The NetherlandsRandomized controlled trialCommunity, home, or retirement homePatients—intervention: n=38; control: n=33Knee arthroplastyPainCoach appMobile appMedication management; pain control or management; rehabilitation (physical therapy and occupational therapy)
    Pugliese et al [96], 2019CanadaFeasibility (pilot) studyCommunity, home, or retirement homePatients—intervention: n=30StrokeRecoverNowMobile appEnhancing patient-provider communication; rehabilitation (physical therapy and occupational therapy)
    Reid et al [97], 2012CanadaRandomized controlled trialCommunity, home, or retirement homePatients—intervention: n=115; control: n=118Cardiac diseaseCardioFit internet-based expert systemWeb appImproving physical activity
    Requena et al [98], 2019Spain2-arm open-label nonrandomized studyCommunity, home, or retirement homePatients—intervention: n=107; control: n=52StrokeFARMALARMMobile appEnhancing patient-provider communication; enhancing patients’ knowledge, skills, and confidence; improving physical activity; medication management; controlling vascular risk factors
    Rian et al [99], 2022NorwayRandomized controlled trialCommunity, home, or retirement homePatients—intervention: n=134Knee arthroplastyEir (Eir Solutions AS)Web appEnhancing patient-provider communication; detecting any postoperative issues; medication management
    Rosner et al [100], 2018CanadaCohort studyCommunity, home, or retirement homePatients—intervention: n=371Orthopedic fracture (any)Internet-based orthopedic patient self-reports of postdischarge complicationsMobile appEnhancing patient-provider communication; improving symptom management; assessing rates of complications
    Saunders et al [101], 2021AustraliaRandomized controlled trialCommunity, home, or retirement homePatients—intervention: n=50; control: n=49Hip osteoarthritisMy Hip JourneyWeb app and email remindersEnhancing caregiver preparedness; enhancing patient-provider communication; enhancing patients’ knowledge, skills, and confidence; improving patient understanding; increasing self-care; improving physical activity; encouraging lifestyle changes; improving quality of life
    Schenkel et al [102], 2020United StatesFeasibility (pilot) studyCommunity, home, or retirement homePatients—intervention: n=28; control: n=28Lung transplantationActiCareWeb appEnhancing caregiver knowledge and skills; enhancing patient-provider communication; monitoring pulse, oxygen, HR, BP, and weight at home; enhancing patients’ knowledge, skills, and confidence; increasing self-care; detecting any postoperative issues; encouraging lifestyle changes; medication management; nutrition support; rehabilitation (physical therapy and occupational therapy); tracking appointments
    Scheper et al [103], 2019The NetherlandsCohort studyCommunity, home, or retirement homePatients—intervention: n=69Total hip replacement and knee arthroplastyWoundcareMobile appEnhancing patient-provider communication; ability to identify symptoms of poor wound healing; detecting any postoperative issues; pain control or management; wound care; prevention of prosthetic joint infection
    Schneider and Howard [104], 2017United StatesDescriptive studyCommunity, home, or retirement homePatients—intervention: n=44; control: n=42StrokeTechnology-improved coping for patients after strokeMobile appImproving patient understanding; improving symptom management; follow-up appointments with primary care provider; medication management; managing emotional changes
    Schubart [105], 2012United StatesFeasibility (pilot) studyCommunity, home, or retirement homePatients—intervention: n=14Spinal cord injurye-Learning program to prevent pressure ulcers in adults with spinal cord injuryWeb appPressure ulcer prevention; pressure ulcer management
    Scott et al [106], 2017United StatesMixed methods studyCommunity, home, or retirement homePatients—intervention: n=20Colorectal surgeryPostoperative mHealth appMobile appNot reported
    Siegel et al [107], 2016United StatesFeasibility (pilot) studyNot reportedPatients—intervention: n=3StrokePHAw stroke appMobile appEnhancing patient-provider communication; follow-up appointments with primary care provider; medication management
    Stapler et al [108], 2022United StatesCase-control, retrospective analysisCommunity, home, or retirement homePatients—preintervention group: n=1052; postintervention group: n=668Elective colon and rectal surgery; colorectal neoplasia, diverticulitis, IBDx, and other diseases of the colon and rectumSt. Joseph\'s Health AppMobile appDetecting any postoperative issues; nutrition support; rehabilitation (physical therapy and occupational therapy); wound care
    Su and Yu [109], 2021ChinaRandomized controlled trialCommunity, home, or retirement homePatients—intervention: n=73; control: n=73Coronary heart diseaseNeCRyWeb appPromoting mental well-being; enhancing patients’ knowledge, skills, and confidence; increasing self-care; detecting any postoperative issues; improving physical activity; encouraging lifestyle changes; assessing patients’ needs; improving quality of life; cardiac rehabilitation
    Sureshkumar et al [110], 2016IndiaFeasibility (pilot) studyCommunity, home, or retirement homePatients—intervention: n=60StrokeCare for Stroke interventionMobile app and web appEnhancing functional skills and activities of daily living
    Symer et al [111], 2017United StatesFeasibility (pilot) studyCommunity, home, or retirement homePatients—intervention: n=31Major abdominal surgeryGastrointestinal mHealth appMobile app and wearable deviceManaging mood and anxiety; ability to identify symptoms of poor wound healing; detecting any postoperative issues; improving symptom management; wound care; decreasing length of hospital stay
    Timmers et al [112], 2019The NetherlandsRandomized controlled trialCommunity, home, or retirement homePatients—intervention: n=114; control: n=99Knee arthroplastyThe Patient Journey AppMobile appEnhancing patients’ knowledge, skills, and confidence; increasing self-care; pain control or management; rehabilitation (physical therapy and occupational therapy); improving quality of life; wound care
    Tolentino [113], 2020United StatesCase-control, retrospective studyCommunity, home, or retirement homePatients—intervention: n=50; control: n=50Multiple conditionsMeducationMobile appMedication management
    Torri et al [114], 2018ItalyQuasi-experimental studyCommunity, home, or retirement homePatients—intervention: n=26; control: n=27Coronary artery disease, cardiac surgery, congestive HF, percutaneous coronary revascularization, or acute ischemic eventsCRMPzMobile appImproving physical activity; encouraging lifestyle changes; medication management; improving quality of life
    Van den Berg et al [115], 2016AustraliaProof-of-concept trialCommunity, home, or retirement homePatients—intervention: n=31; control: n=32StrokeCARE4STROKEMobile app and wearable deviceEnhancing patient-provider communication; improving physical activity; early weight bearing (weight bearing as tolerated); encouraging ambulation; rehabilitation (physical therapy and occupational therapy); improving quality of life
    Venkatraman et al [116], 2022United StatesFeasibility (pilot) studyCommunity, home, or retirement homePatients—intervention: n=69Cardiac surgery and aortic stenosisMMSaaMobile appAbility to identify symptoms of HF; enhancing patients’ knowledge, skills, and confidence; increasing self-care; recording baseline and postoperative PROs
    Vincent et al [117], 2021CanadaQualitative study; qualitative usability studyCommunity, home, or retirement homePatients and caregivers—intervention: n=17Hip fractureMy-HFabMobile appEnhancing patient-provider communication; managing mood and anxiety; enhancing patients’ knowledge, skills, and confidence
    Visperas et al [118], 2021United StatesRandomized controlled trialCommunity, home, or retirement homePatients—intervention: n=204; control: n=195Total hip replacement and knee arthroplastyJointCOACHWeb appEnhancing patient-provider communication; enhancing patients’ knowledge, skills, and confidence; detecting any postoperative issues; medication management; pain control or management; rehabilitation (physical therapy and occupational therapy)
    Vloothuis et al [119], 2019The NetherlandsRandomized controlled trialCommunity, home, or retirement homeIntervention: n=32; control: n=34—patient-caregiver dyadsStrokeCARE4STROKE digital interventionWeb appManaging mood and anxiety; increasing self-care; improving physical activity; improving quality of life; improving motor impairment, strength, walking ability, balance, mobility, and (extended) activities of daily living of patients; reducing caregiver strain; reducing fatigue; improving quality of life of both patients and caregivers
    Vonk Noordegraaf et al [120], 2014The NetherlandsRandomized controlled trialCommunity, home, or retirement homePatients—intervention: n=110; control: n=105Gynecological surgeryPersonalized eHealth program after gynecological surgeryWeb appEnhancing patient-provider communication; improving symptom management; achieving self-empowerment
    Wang et al [121], 2017ChinaRandomized controlled trialCommunity, home, or retirement homePatients—intervention: n=55; control: n=65Chronic obstructive pulmonary diseaseWeb-based coaching program using EHRsacWeb appEnhancing patient-provider communication; increasing self-care; improving symptom management; assessing patients’ needs
    Wang et al [122], 2018ChinaRandomized controlled trialCommunity, home, or retirement homePatients—intervention: n=100; control: n=103StomaStoma home care mobile appMobile appEnhancing psychosocial adjustment; fostering self-efficacy; assessing stoma complication incidence
    Werhahn et al [123], 2019GermanyFeasibility (pilot) studyCommunity, home, or retirement homePatients—intervention: n=10HFCPMPadMobile app and wearable deviceMonitoring pulse, oxygen, HR, BP, and weight at home; ability to identify symptoms of HF; improving physical activity; encouraging lifestyle changes; improving symptom management; assessing patients’ needs; assessing rates of complications; medication management; monitoring physical activity (daily step count); PRO measures
    Willeit et al [124], 2020AustriaRandomized controlled trialCommunity, home, or retirement homePatients—intervention: n=1438; control: n=711StrokeMyStrokecardWeb appEnhancing patient-provider communication; ability to identify symptoms of HF; enhancing patients’ knowledge, skills, and confidence; encouraging lifestyle changes; improving symptom management; improving quality of life; risk factor monitoring

    aDHI: digital health intervention.

    bQoC: quality of care.

    cHF: heart failure.

    dACL: anterior cruciate ligament.

    ePRO: patient-reported outcome.

    fCPR: cardiopulmonary resuscitation.

    gHR: heart rate.

    hBP: blood pressure.

    iPATH: Personal Assistant for Tracking Health.

    jSAFER: Studying Adverse Events From Elective Surgery Research.

    kmHealth: mobile health.

    lSAM: Smart About Meds.

    mOPTILOGG: home intervention system.

    nSMMRT: Secure Messaging for Medication Reconciliation Tool.

    oSPACE: Self-Management Program of Activity Coping and Education.

    pHF-SMART: Heart Failure Self-Management And Readmission Prevention Technique.

    qiADAPT: mobile health platform for strategy training in inpatient stroke rehabilitation.

    rDPE: digital patient engagement.

    sIGB: iGetBetter.

    tMHAV: My Health at Vanderbilt.

    uDTx: digital therapeutics.

    vmVS: mHealth-supported volunteer-assisted self-help.

    wPHA: personal health assistant.

    xIBD: inflammatory bowel disease.

    yNeCR: nurse-led eHealth cardiac rehabilitation.

    zCRMP: cardiac rehabilitation maintenance program.

    aaMMS: ManageMySurgery.

    abMy-HF: My Hip Fracture.

    acEHR: electronic health record.

    adCPMP: cardio patient monitoring platform.

    Platform-based patient-clinician DHIs were implemented using a mobile app (59/97, 61%) [28,30,31,34-36,38,41,43,45-49, 52-57,59,60,62,63,66,70,71,73,74,76,79-84,87,88,90-92, 95,96,98,100,103,104,106-108,111-117,122,123], a web-based platform (28/97, 29%) [32,33,39,40,42,44,50,51,58,61, 64,65,67,68,72,78,85,97,99,101,102,105,109,118-121,124], or a combination of both (10/97, 10%) [29,37,69,75,77,86,89,93,94,110].

    Figure 2 illustrates the frequency distribution of platform-based DHIs by year of publication.

    Only 5% (5/97) of the studies [83,91,96,109,121] included all 3 types of continuity of care [11]. Informational continuity was frequently implemented through patient education and facilitating patient-provider communication. The most common ways in which management continuity was implemented was providing an assessment of the patient, monitoring the patient’s health status after discharge, and facilitating follow-up care. Relational continuity was the least implemented, with only 6% (6/97) of the studies in which the interventions included counseling or rapport building [50,82,91,96,109,121]. A more detailed description of each of the interventions using the Template for Intervention Description and Replication [26] is available in Multimedia Appendix 4 [28-124].

    ‎
    Figure 2. Frequency distribution of platform-based digital health interventions used for care transitions by year.

    Outcome Measures

    The included studies reported various outcomes measures. The most common were grouped as health care use, complications, and wellness outcomes.

    Health Care Use

    A total of 21% (20/97) of the studies reported on readmission rates [36,52-54,57,58,60,66,67,70,80,81,86,87,90,94,102, 108,111,118]. Of the 20 studies, only 3 (15%) [58,102,108] showed a significant improvement, 10 (50%) reported their results as nonsignificant [36,52,60,67,80,81,86,90,94,118], 1 (5%) reported mixed results [66], and 6 (30%) [53,54,57,70,87,111] did not perform a statistical test.

    In total, 8% (8/97) of the studies [36,52,60,80,81,94,108,118] reported on emergency department visits. Of the 8 studies, 2 (25%) [36,108] showed a significant improvement, whereas the remaining 6 (75%) showed no significant improvements.

    Complications

    A total of 8 studies [28,37,52,53,61,80,81,91] reported on complication rates, and only 1 (12%) [91] showed significant improvement in the complication rates compared to the control group; 3 (38%) [52,80,81] showed nonsignificant results, whereas the other 4 (50%) [28,37,53,61] did not perform a statistical test (Table 2).

    Table 2. Studies reporting on health care use and complications.
    StudyName of DHIaParticipantsReadmissionEDb visitsComplicationsDirection and magnitude of effect
    Agri et al [28], 2020MaelaIntervention: n=43—c—NAdAmong the 43 patients, the app detected 12 adverse events, and 10 (83%) were handled through the app.
    Ben-Ali et al [36], 2021SeamlessMDIntervention: n=1108NSeSignificant—ED visits: negative, P=.03, and magnitude not reported; 30-day readmissions: negative, NS, and magnitude not reported
    Birkhäuser et al [37], 2020Cellphone-based health care appIntervention: n=18——NAIn total, 2 patients required readmission within the study period of 90 days because of postoperative complications.
    Eustache et al [52], 2023Same-day discharge mHealthf app (CareSense)Intervention: n=94; control: n=256NSNSNS30-day complications: negative, P=.18, and magnitude not reported; 30-day ED visits: no difference and P=.59; readmissions: positive, P=.35, and magnitude not reported
    Felbaum et al [53], 2018TrackMyRecoveryIntervention: n=56NA—NAThere was 1 postoperative complication. There were no readmissions.
    Ganapathy et al [54], 2017Patient BuddyPatients: n=40; caregivers: n=40NA——A total of 17 patients (42.5%) were readmitted within 30 days.
    Habib et al [57], 2021Medication adherence mobile appIntervention: n=23; control: n=26NA——Hospital readmissions: negative (8.7% for the intervention group vs 15.4% for the control group); ED visits: positive (21.7% for the intervention group vs 19.2% for the control group)
    Hägglund et al [58], 2015Home intervention system (OPTILOGGg)Intervention: n=32; control: n=40Significant——HFh-related days in hospital (readmissions): negative, P<.005, and magnitude not reported
    Heuser et al [60], 2021SeamlessMDIntervention: n=396; control: n=458NSNS—ED visits without subsequent readmission: no difference and P=.65; ED visits with subsequent readmission: no difference and P=.99; readmissions: no difference and P=.97
    Heyworth et al [61], 2014SMMRTiIntervention: n=60——NA23 potential adverse drug events observed
    Indraratna et al [66], 2022TeleClinical CareIntervention: n=81; control: n=83Mixed——Unplanned 30-day readmissions: no difference, P=.97, and magnitude not reported; total readmissions at 6 months: negative, P=.02, and magnitude not reported; cardiac readmissions at 6 months: negative, P=.03, and magnitude not reported
    Johnson et al [67], 2022HF-SMARTjIntervention: n=16; control: n=15NS——30-day readmissions: positive, P=.65, and magnitude not reported; 90-day readmissions: positive, P=.70, and magnitude not reported
    Keng et al [70], 2020Home to Stay digital program after colorectal surgeryIntervention: n=106NA——The 30-day readmission rate was 6% and lower than the 30-day readmission rate of 18% reported for the 4 months before the start of the study.
    Lee et al [80], 2022Mobile app follow-up for same-day dischargeIntervention: n=48; control: n=73NSNSNS30-day complications: positive, P=.81, and magnitude not reported; 30-day ED visits: positive, P=.66, and magnitude not reported; 30-day readmissions: positive, P=.68, and magnitude not reported
    Lee et al [81], 2022mHealth remote postdischarge monitoringIntervention: n=70; control: n=35NSNSNSED visits: no difference and P>.99; readmissions: negative, P=.37, and magnitude not reported; incidence of 30-day complications: negative, P=.58, and magnitude not reported
    María Gómez et al [86], 2022mHealth app for patients with type 2 diabetes transitioning from inpatient to outpatient careIntervention: n=41; control: n=45NS——Hospitalization for diabetes: negative, P=.06, and magnitude not reported
    Marvel et al [87], 2021Acute myocardial infarction DHIIntervention: n=200; control: n=864NA——Risk of readmission within 30 days after discharge: negative, P=.02, and magnitude not reported
    Paruchuri et al [90], 2021WellframeIntervention: n=118; historical control group: n=343NS——All-cause readmission within 30 days: negative, P=.70, and magnitude not reported; all-cause readmission within 90 days: negative, P=.39, and magnitude not reported
    Peng et al [91], 2022Mobile continuous nursing platformIntervention: n=47; control: n=47——SignificantTotal complication rates: negative, P<.05, and magnitude not reported
    Pooni et al [94], 2022Home to Stay appIntervention: n=128; control: n=125NSNS—30-day ED visits: negative, P=.49, and magnitude not reported; 30-day readmissions: negative, P=.55, and magnitude not reported
    Schenkel et al [102], 2020ActiCareIntervention: n=28; control: n=28Significant——Hospital readmissions (events): negative, P<.001, and magnitude not reported
    Stapler et al [108], 2022St. Joe’s Health AppPatients (preintervention group: n=1052; postintervention group: n=668)SignificantSignificant—Readmissions: negative, P<.001, and magnitude not reported; ED visit rate: negative, P<.001, and magnitude not reported
    Symer et al [111], 2017Gastrointestinal mHealth appIntervention: n=31NA——One patient was readmitted.
    Visperas et al [118], 2021JointCOACHIntervention: n=204; control: n=195NSNS—ED visits: no difference and NS; readmissions: no difference and NS

    aDHI: digital health intervention.

    bED: emergency department.

    cMissing data or not applicable.

    dNA: not available.

    eNS: nonsignificant.

    fmHealth: mobile health.

    gOPTILOGG home intervention system.

    hHF: heart failure.

    iSMMRT: Secure Messaging for Medication Reconciliation Tool.

    jHF-SMART: Heart Failure Self-Management And Readmission Prevention Technique.

    Wellness Outcomes

    A total of 14% (14/97) of the studies reported on quality of life [31,45,48,50,59,65,67,69,82,85,91,97,109,120]. Of the 14 studies, 8 (57%) [48,50,65,69,85,91,97,120] showed a significant improvement, whereas the other 6 (43%) reported their results to be nonsignificant. In total, 8 studies [31,51,68,76,82,91,109,115] were conducted on self-care, and 4 (50%) [82,91,109,115] showed significant results. In addition, 6 studies [31,51,65,94,119,122] reported on mental health outcomes, with 4 (67%) [65,94,119,122] showing significant improvements. A total of 8 studies [29,41,42,50,97,109,114,123] were identified for physical activity, with 5 (62%) [41,97,109,114,123] showing significant results (Table 3).

    Table 3. Wellness outcomes.
    StudyName of DHIaParticipantsQuality of lifeSelf-careMental healthPhysical activityDirection and magnitude of effect
    Antypas and Wangberg [29], 2014Internet- and mobile-based tailored intervention to enhance maintenance of physical activity after cardiac rehabilitationIntervention: n=7; control: n=12—b——MixedPhysical activity 1 month after discharge: positive, Kolmogorov-Smirnov Z=0.823, and P=.38; physical activity 3 months after discharge: positive, Kolmogorov-Smirnov Z=1.397, and P=.02
    Athilingam et al [31], 2017Mobile app to improve self-care behaviors and quality of life for patients with HFcIntervention: n=9; control: n=90NSdMixedNS—Self-care maintenance: positive, t11=0.083 and P=.93; self-care management: positive, t11=3.38 and P=.01; self-care confidence: positive, t11=2.53 and P=.28; depression: negative, t11=1.97 and P=.07; quality of life: negative, t11=–1.43 and P=.18
    Cheng et al [41], 2022Mobile app for home-based rehabilitation after hip fractureIntervention: n=19; control: n=20———SignificantFirst-month exercise adherence: positive, P=.03, and magnitude not reported
    Cox et al [42], 2015ActivOnlineIntervention: n=10———NAeParticipants recorded a mean of 35 (range 15-57) physical activity sessions during the intervention period, equating to a mean of 4 recorded sessions of physical activity each week.
    De Batlle et al [45], 2021CONNECAREIntervention: n=48; control: n=28NS———Quality of life (SF-12f): positive, P=.10, and magnitude not reported
    Devito Dabbs et al [48], 2016Pocket PATHgIntervention: n=99; control: n=102Significant———Self-care: positive, group effect size=1.67, and P=.59
    Duan et al [50], 2018Health behavior intervention for patients with coronary heart disease through the webIntervention: n=44; control: n=39Significant——NSQuality of life: positive, F1, 79=16.36, and P<.001; physical activity: positive, F1, 81=1.33, and P=.25
    Dukeshire et al [51], 2012Website tailored to women recovering at home after hysterectomyIntervention: n=31——NA—The website reduced anxiety and worry for patients.
    Heiney et al [59], 2020Healthy HeartIntervention: n=12NSNS——Quality of life: positive, P=.15, and magnitude not reported; Self-Care of Heart Failure Index—maintenance: difference score=9.37 and P=.15; Self-Care of Heart Failure Index—management: difference score=15.00 and not applicable (presample too small); Self-Care of Heart Failure Index—confidence: difference score=7.04 and P=.17
    İlaslan and Özer [65], 2022Web-based training and follow-up for patients with HFIntervention: n=32; control: n=32Significant—Significant—Quality of life—LVD-36h: negative, F=77.01, and P<.001
    Johnson et al [67], 2022HF-SMARTiIntervention: n=16; control: n=15NS———Quality of life at 30 days: positive, P=.09, and magnitude not reported; quality of life at 90 days; negative, P=.10, and magnitude not reported
    Kang et al [68], 2022Web-based discharge education programIntervention: n=43; control: n=42—NS——Self-care ability over time: positive, F1, 60=8.934, and P=.004 (significant); self-care ability—group and time interaction: positive, F1, 60=3.007, and P=.09
    Kargar et al [69], 2020Self-care educational mobile app for burnsIntervention: n=30; control: n=30Significant———Quality of life: positive, P<.001, and magnitude not reported
    Kooij et al [76], 2021Self-management app for high-risk patients with chronic obstructive pulmonary diseasePatients: n=39—NS——Self-management knowledge and coping: positive, P=.75, and magnitude not reported
    Liu et al [82], 2021TogetherIntervention: n=49; control: n=49NSSignificant——Self-efficacy: positive, F=8.506, and P=.004; quality of life: positive, F=0.082, and P=.78
    Lyu et al [85], 2021Nurse-led web-based transitional care programIntervention: n=58; control: n=58Significant———Quality of life: positive, d=0.52, and P<.01; self-efficacy: positive, d=0.50, and P<.01
    Peng et al [91], 2022Mobile continuous nursing platformIntervention: n=47; control: n=47SignificantSignificant——Self-care ability: positive, P<.05, and magnitude not reported; quality of life (SF-36j): positive, P<.05, and magnitude not reported
    Pooni et al [94], 2022Postdischarge Home to Stay mobile appIntervention: n=128; control: n=125——Significant—Feeling worried or anxious: negative and P<.001
    Reid et al [97], 2012CardioFit internet-based expert systemIntervention: n=115; control: n=118Significant——SignificantPedometer-measured steps per day: positive, F=5.226, and P=.02; heart disease health-related quality of Life (27-item MacNew instrument): positive, F=1.785, and P=.11
    Su and Yu [109], 2021NeCRk systemIntervention: n=73; control: n=73NSSignificant—SignificantMean daily steps 6 weeks after the intervention: positive, P=.02, and magnitude not reported; mean daily steps 12 weeks after the intervention: positive, P=.006, and magnitude not reported; self-efficacy: positive, P=.005, and magnitude not reported; MacNew health-related quality of life, positive, P=.06, and magnitude not reported
    Torri et al [114], 2018CRMPlIntervention: n=26; control: n=27———SignificantSelf-reported physical activity: positive, P=.35, and magnitude not reported
    Van den Berg et al [115], 2016CARE4STROKEIntervention: n=31; control: n=32—Significant——Self-efficacy: positive, P=.008, and magnitude not reported
    Vloothuis et al [119], 2019CARE4STROKE digital interventionIntervention: n=32; control: n=34——Significant—Patient anxiety: negative, P=.02, and magnitude not reported; caregiver depression: negative, P=.003, and magnitude not reported
    Vonk Noordegraaf et al [120], 2014Personalized eHealth program after gynecological surgeryIntervention: n=110; control: n=105Significant———Quality of life: positive, between-group mean total score difference=30 (95% CI 4-57), and P=.02 (significant)
    Wang et al [122], 2018Stoma home care mobile appIntervention: n=100; control: n=103——Significant—Psychosocial adjustment (1-, 3-, and 6-month follow-ups): positive, F=81.21, and P<.001
    Werhahn et al [123], 2019CPMPmPatients: n=10———SignificantMean daily step count: positive, P<.001, and magnitude not reported

    aDHI: digital health intervention.

    bMissing data or not applicable.

    cHF: heart failure.

    dNS: nonsignificant.

    eNA: not available.

    fSF-12: 12-Item Short Form Health Survey.

    gPATH: Personal Assistant for Tracking Health.

    hLVD-36: left ventricular dysfunction questionnaire.

    iHF-SMART: Heart Failure Self-Management And Readmission Prevention Technique.

    jSF-36: 36-Item Short Form Health Survey.

    kNeCR: nurse-led eHealth cardiac rehabilitation.

    lCRMP: cardiac rehabilitation maintenance program.

    mCPMP: cardio patient monitoring platform.

    Patient, Caregiver, and Health Care Provider Barriers

    Eight unique barriers were identified in the included studies: (1) lack of interest (13/97, 13%) [28,34,56,63,64,70,76,89,95,106,107,118,124], (2) time constraints (10/97, 10%) [44,54,56,76,78,79,96,106,109,115], (3) technological issues (7/97, 7%) [41,54,62,79,88,96,111], (4) usability issues (7/97, 7%) [42,62,71,76,96,107,117], (5) language barrier (4/97, 4%) [28,66,89,96], (6) irrelevant content of DHIs (3/97, 3%) [96,106,117], (7) lack of comfort (3/97, 3%) [78,115,117], and (8) lack of support and engagement (1/97, 1%) [106].

    Patient, Caregiver, and Health Care Provider Enablers

    Seven unique enablers were identified: (1) ability to use the DHI (17/97, 18%) [28,36,62,64,67,70,76,78,80,81,89, 96,99,101,111,116,117], (2) ease of use (11/97, 11%) [49,55,57,58,68,76,85,101,105,111,121], (3) ability to collaborate with patients (1/97, 1%) [44], (4) caregiver support (1/97, 1%) [115], (5) confidence in the technology (1/97, 1%) [51], (6) convenience of using the DHIs (1/97, 1%) [62], and (7) participation in the development and implementation processes (1/97, 1%) [45] (Multimedia Appendix 5 [10,28,31,33,34,36,38-42,44,45,49,51,54-59,61-68,70,71,75, 76,78-82,85,87-90,93,95,96,99,101,105-107,109,111,112,115-118,121,123,124]).

    Conflicting Themes

    In total, 3 themes were identified as both barriers and enablers. Many studies (15/97, 15%) reported that patients or caregivers were limited by their access to technology or the internet (barrier) [28,36,51,54,56,61,63,70,75,90,99,103,107,111,118], whereas other studies (28/97, 29%) reported that the patients or caregivers had access to these resources (enabler) [28,39,42,51,54,58,61,64,65,67,70,75,76,79-82,90,93,95,99, 101,105,109,112,116,118,121]. Similarly, a few studies (4/97, 4%) reported that participants had difficulty with understanding the DHIs (barrier) [28,49,64,117], whereas other studies (19/97, 20%) reported that the DHIs were easy to understand (enabler) [31,33,34,38,49,55,57,58,68,76,80,81,85,87,93,101,105,111,121]. Finally, a recurring theme that acted as both a barrier (11/97, 11%) [31,36,59,63,64,89,99,101,107,112,118] and an enabler (17/97, 18%) [39,40,42,58,59,64,65,76,78,82,90,99, 101,109,116,118,123] was whether the participants had digital literacy to use the DHIs.


    Summary

    In this scoping review, we summarized the current evidence on platform-based patient-clinician DHIs specific to hospital-to-home care transitions and the reported barriers to and enablers of the uptake and implementation of these platform-based patient-clinician DHIs.

    Mobile Apps Versus Web-Based Platforms

    Most of the included studies used either a mobile app (59/97, 61%) or a combination of a mobile app and a web-based platform (10/97, 10%). Apps are unique because they are software programs that have been developed to run on a mobile device and are tailored to achieve a specific goal [125]. This is interesting because many studies have used other digital health tools, including e-charts [126], telehealth [127], and monitoring devices [128]. This trend may illustrate the benefits of using a mobile app over other types of digital health tools. This can include convenience, such as portability; effective communication; using a point of care for many different purposes; and immediate up-to-date information, guidelines, or medical literature [129]. Mobile apps have multiple uses in health care and have demonstrated numerous benefits, such as improved accuracy of patient documentation, improved workflow patterns or efficiency, and increased productivity of health care providers [129]. More specifically, the continuity of care between the hospital and the home.

    Effectiveness of Platform-Based DHIs

    The included studies had a broad range of outcome measures, and overall, these outcomes showed mixed results. The studies on platform-based DHIs did not show a significant improvement in readmission rates (only 3/20, 15% showed significance), emergency department visits (only 2/8, 25% showed significance), or complication rates (only 1/8, 12% showed significance). However, the studies reported promising results for quality of life (8/14, 57% of the studies), self-care (4/8, 50% of the studies), mental health (4/6, 67% of the studies), and physical activity (5/8, 62% of the studies). Further research is needed to better plan and evaluate the overall effectiveness of these specific DHIs by clearly linking outcomes with specific interventions.

    Barriers to and Enablers of the Uptake and Implementation of Platform-Based DHIs

    The most prominent barriers were lack of interest and time constraints to use the DHIs, and the most prominent enablers reported were the ability to use the DHIs and their ease of use. This reveals the importance of simple, user-friendly DHIs as the patient’s confidence in using them will determine how engaged they are throughout the intervention. Another important factor that plays a role in whether DHIs will be successful is whether the patient has access to the proper technological resources. This came up as a prominent barrier if they lacked the appropriate resources or as an enabler if they possessed what they needed. This reveals an important factor when considering the implementation of DHIs as the target population must have access to the correct resources to allow the intervention to take place.

    Strengths and Limitations

    Our study had several strengths and limitations. We designed an in-depth a priori protocol. The search strategy was developed and peer reviewed by a research librarian with extensive knowledge of scoping and systematic review methodologies. This scoping review was unique in that it specifically examined platform-based patient-clinician DHIs and not all types of DHIs. This allowed us to examine interventions that implemented elements that may promote more patient engagement, foster better communication between patients and health care providers, and integrate everything needed into one convenient program. The wide variety of studies included in this review led to a wide range of outcomes. We focused on the outcomes of health care use, complications, and wellness during the transition from hospital to home. Some other outcomes were excluded as they were specific to the disease or procedure performed. In addition, this review did not limit the inclusion to one type of health condition. However, this allowed us to examine DHIs across multiple areas of research and evaluate barriers to and enablers of DHI implementation across health conditions.

    We identified a substantial body of literature on platform-based DHIs and their role in supporting patient care transitions from hospital to home. Most studies (95/97, 98%) primarily focused on patients’ use of these DHIs. While patients are central to health care delivery, it is equally important to evaluate the effectiveness of platform-based DHIs from the health care providers’ perspective. If these systems are not user-friendly for providers, widespread adoption is unlikely. Therefore, a deeper understanding of how providers interact with DHIs is essential for their successful implementation.

    The transition of patients from hospital to home is a critical process that must be carried out safely and efficiently. However, this process is inherently complex due to factors such as unclear provider roles, suboptimal communication, and the patient’s ability to manage their own care [130]. When transitions are not carried out effectively, patient care can be compromised, leading to negative outcomes [131]. Platform-based DHIs offer a promising solution to help streamline care during this vulnerable period, potentially improving the quality and safety of transitions. The findings of this work can inform future work on DHIs and, more specifically, the “MyPath to Home” DHI previously piloted for the population with hip fracture during their transition from hospital to home [33].

    Conclusions

    There is a lot of potential for using DHIs for care transitions; however, the specific elements that will improve patient outcomes need to be further explored. Specifically, further work is needed to involve all key stakeholders in the design, development, and implementation of these DHIs and understand their effectiveness to embed them in practice more broadly.

    Acknowledgments

    The authors thank Valentina Ly, master of library and information studies (Health Sciences Library, University of Ottawa), for peer review of the MEDLINE search strategy. This work received no funding.

    Data Availability

    All data generated or analyzed during this study are included in this published article and its supplementary information files.

    Authors' Contributions

    Concept and design were conducted by CB, SP, SV, ALSFdM, GMdML, and AH. Data acquisition and analysis were conducted by RP, ATK, and CB. Drafting of the manuscript was conducted by RP and CB. All authors critically revised the manuscript.

    Conflicts of Interest

    None declared.

    Multimedia Appendix 1

    PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) checklist.

    PDF File (Adobe PDF File), 509 KB
    Multimedia Appendix 2

    Search strategies.

    DOCX File , 38 KB
    Multimedia Appendix 3

    List of excluded studies.

    XLS File (Microsoft Excel File), 87 KB
    Multimedia Appendix 4

    Description of the interventions.

    DOCX File , 96 KB
    Multimedia Appendix 5

    Barriers and enablers.

    DOCX File , 32 KB
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    ‎
    DHI: digital health intervention
    PRISMA-ScR: Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews

    Edited by A Mavragani; submitted 22.12.23; peer-reviewed by K Beatty, M Sadiq; comments to author 18.09.24; revised version received 16.10.24; accepted 07.11.24; published 30.12.24.

    Copyright

    ©Chantal Backman, Rosie Papp, Aurelie Tonjock Kolle, Steve Papp, Sarah Visintini, Ana Lúcia Schaefer Ferreira de Mello, Gabriela Marcellino de Melo Lanzoni, Anne Harley. Originally published in the Journal of Medical Internet Research (https://www.jmir.org), 30.12.2024.

    This is an open-access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work, first published in the Journal of Medical Internet Research (ISSN 1438-8871), is properly cited. The complete bibliographic information, a link to the original publication on https://www.jmir.org/, as well as this copyright and license information must be included.