Using mHealth technology to identify and refer surgical site infections in Rwanda

 描述(申请人提供)：手术部位感染(SSI)是全世界发病率和死亡率的重要原因，特别是在低收入和中等收入国家，在这些国家，地理和基础设施障碍往往推迟或阻止术后患者返回护理。在这些设置下，SSI的比率可以达到30%。在拟议研究的地点卢旺达，目前的护理标准不包括对手术后患者的随访。在那里，雇用了社区卫生工作者网络，为孕妇和产后妇女以及五岁以下儿童提供护理和后续服务。然而，这些工人有限的教育和现有的工作量使他们无法支持其他专门疾病的后续治疗，如术后患者。在这项拟议的研究中评估的干预措施试图解决这些差距。这项研究的第一个目的是优化筛查方案，以确定在基热河地区医院(KDH)接受手术的患者术后10天发生SSI的情况。这项研究的最初阶段将包括首先由全科医生筛查450名患者，然后由外科CHW(SCW)使用六个问题方案进行筛查。该方案将经过优化程序，并报告最终的敏感性和特异性。第二个目的是评估由配备了mHealth支持的sCHW提供的SSI筛查方案对SSI患者术后10天的返照率的影响。将对两种CHW-mHealth干预措施进行评估。在第一项研究中，Schw将在术后研究参与者的家中探访他们，以执行手机提示的筛查方案。在第二种情况下，Schw会打电话给患者，并通过电话执行相同的筛查方案。在这一阶段的研究中，400名患者将被分配到每个分娩臂，并将适当的恢复率与接受标准护理(即没有随访)的对照组400名患者的适当恢复率进行比较。还将报告进程指标，以描述CHW-mHealth干预措施的可行性。我们相信，通过CHW-mHealth干预措施实施的SSI筛查方案可以支持SSI的准确诊断，并将患者转回医院进行适当的后续护理。研究小组与卢旺达卫生部同事的密切合作将促进干预措施的扩大，如果证明有效的话。这项研究的结果还将为在其他疾病领域制定类似的移动健康干预措施提供参考，使社区卫生组织能够将服务扩展到非洲农村地区的其他专门患者。

 DESCRIPTION (provided by applicant): Surgical site infections (SSI) are a significant cause of morbidity and mortality worldwide, and particularly in low- and middle-income countries, where geographic and infrastructural barriers often delay or prevent post- operative patients from returning to care. In these settings, rates of SSI can reach 30%. In Rwanda, the site of the proposed research, the current standard of care does not include follow-up of post-operative surgical patients. There, a network of community health workers (CHWs) are employed to provide care and follow-up for pregnant and post-partum women as well as children under five years of age. However, the limited education and existing work load of these workers preclude them from supporting the follow-up of other specialized conditions, such as post-operative patients. The interventions evaluated in this proposed research seeks to address these gaps. The first aim of this study is to optimize a screening protocol to identify SSI in patients receivig surgery at Kirehe District Hospital (KDH) 10 days post-operation. This initial phase of research will involve screening 450 patients first by a general practitioner and then by a surgical CHW (sCHW) using a six question protocol. The protocol will undergo an optimization procedure and the final sensitivity and specificity reported. The second aim is to evaluate the impact of SSI screening protocol, delivered by sCHWs equipped with mHealth support, on the rate of return to care for patients with SSI 10 days post-operation. Two CHW-mHealth interventions will be evaluated. In the first, a sCHW will visit post-operative study participants in their homes to administer the screening protocol prompted by the mobile phone. In the second, a sCHW will call the patient and administer the same screening protocol over the phone. In this phase of the research, 400 patients will be assigned to each of these delivery arms, and the rates of appropriate return to care will be compared to that of 400 patients in a control arm receiving the standard of care (i.e. no follow-up). Process indicators also will be reported to describe the feasibility of CHW-mHealth interventions. We believe that the SSI screening protocol administered via CHW-mHealth interventions can support accurate diagnosis of SSI and refer patients back to the hospital for appropriate follow-up care. The research team's close collaboration with colleagues at the Rwanda Ministry of Health will facilitate the scale-up of the intervention, should it prove efficacious. Results of this study will also inform the development o similar mHealth interventions across other disease areas, allowing CHWs to expand services to other specialized patients in rural African settings.