Current use of Patient Generated Health Data and mhealth Technology to Track Post- Surgical Wounds

Transcription

1 Current use of Patient Generated Health Data and mhealth Technology to Track Post- Surgical Wounds Joe Sharma, MD, FACS, FACE Associate Professor of Surgery Chief Quality Officer Emory University School of Medicine

2 Disclosures ASSIST (Assessing Surgical Site Infection Surveillance Technologies) Member

3 Goals Gain an understanding of the current use of mhealth and PGHD in post-operative wound management Health Technology Assessment Literature Review Stakeholder Interviews

4 Mobile Post- Operative Wound Evaluator

5 Methods Literature search Publications specific to (1) mobile devices/pghd AND (2) postdischarge/post-operative period AND (3) wounds/surgical site infections/images. PubMed, Embase, Scopus, Web of Science, CINAHL, ProQuest Dissertations & Theses, ACM Digital Library, SciFinder, Inspec, and Compendex Review of abstracts Exclusion criteria: Chronic conditions/leg ulcers General pre/post-op management (no PGHD) No clinical application Duplicate of other manuscript Non-surgical topic (eg: burns, trauma wounds) Remaining abstracts were either included in final review or tagged for background purposes

6 Broad search of literature for relevant references n=4000+ References included n=126 References excluded n=3800+ Methods Abstracts included for full review n=34 Abstracts tagged for background use n=18 Abstracts excluded from review n=74 Full manuscripts included in evidence review n=26 Conference abstracts or research briefs included in evidence review n=8

7 Findings Study Type Randomized Controlled Quality Improvement Qualitative Cost Effectiveness Case Series Cohort Feasibility/Pilot % 5% 5% 10% 10% 3% 3% 5% Surgical Specialty 27% 15% 12% General (11) Vascular (6) Orthopedic (5) Pediatric (4) Reconstructive (4) Cardio/Thoracic (2) Colorectal (2) OB/GYN (2) Otolaryngology (1) Urology (1) N/A (2)

8 Findings Outcomes Measured SSI was a specific outcome in 12 manuscripts 1 used CDC guidelines 4 used subsets of signs/symptoms 7 used unspecified criteria Length of follow-up ranged from 72 hours to 6 weeks post-op 16 manuscripts did not specify length of follow-up 15 manuscripts reported on real-world use of a mobile app 18 were theoretical use or did not use a mobile app for data collection 1 did not specify app use 30 manuscripts included patients or their caregivers as population of study 3 included care providers 1 included patient advocates 1 included community health workers 2 used wound photos as unit of analysis 1 was cost effectiveness only Primary Outcome Secondary Outcome

9 Observations/Themes Patient-submitted photos aided in identification of post-op complications, reduced ER visits/hospital readmissions, and altered courses of care. Inter-rater agreement was moderate to high in assessment of wound photos and subsequent clinical recommendations. Patients and clinicians gave high satisfaction and usability ratings. Patient success in using mhealth apps (e.g., taking/submitting wound photos) was moderate to high. The quality of digital photos was sufficient for clinical use.

10 Recommendations Nascent field, difficult to draw conclusions Opportunities Collaboration with other fields Radiology Chronic Wounds Burns Dermatology

11 Stakeholder Interviews Twenty interviews Design, Clinician, Vendor, Data Science, Research Surgeons, C-suite, Patients, Researchers, Infection preventionists

12 Provider User Experience For providers, the primary value of PGHD is the ability to remotely monitor for early detection of SSI. Opportunity for non-physician providers Concerns about the variability/quality of devices

13 Provider Perspectives on Patient User Experience The patient s role is in the prevention phase, but once an SSI is brewing, attention from the physician is required. Providers report improved patient compliance and communication training and education are needed to ensure photo quality Wounds maybe distressing to patients Patients desire a feedback mechanism as part of an mhealth platform

14 Data Integration Robust surveillance depends on an institution s resources Current PGHD-integration practices are informal and lack standardization of workflows, roles, and data streams. One way vs. two way standards development Lost in EHR

15 Definition of SSI using PGHD A major challenge is visual definition of SSI vs. physiological definition. Cultures are not available Some symptoms are difficult to track The data points most commonly mentioned across interviews included color (redness), temperature, erythema, drainage, necrosis, wound depth (size, open or closed, presence of sutures), and patient self-report. Providers have haptic-feedback

16 Thank you to ASSIST Team!!