Patient-Centered Postoperative Wound Surveillance Using Current Technology

使用当前技术以患者为中心的术后伤口监测

• 批准号: 8772387
• 负责人: K CRAIG Kent
• 金额: $ 29.92万
• 依托单位: UNIVERSITY OF WISCONSIN-MADISON
• 依托单位国家: 美国
• 财政年份: 2014
• 资助国家: 美国
• 起止时间: 2014-07-01 至 2017-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8772387
• 关键词: Patient; Centered; Postoperative; Wound; Surveillance

DESCRIPTION (provided by applicant): Surgical site infection (SSI) is the most common nosocomial infection in surgical patients and accounts for 38% of post-operative complications. SSI and additional wound complications result in physical and emotional stress for a significant number of patients and their families and can lead to readmission, reoperation, limb loss, or death. Wound complications also produce increased health care costs, and we have found that SSI is the leading cause of unplanned, potentially preventable hospital readmissions for surgical patients. If diagnosed at an early stage, SSI can be treated in the outpatient setting with oral antibiotics and wound care, precluding the need for readmission, intravenous antibiotics, and reintervention. However, patients rarely recognize early stage wound infections and often present with an advanced infection that requires intensive treatment and rehospitalization. Interventions have been employed to prevent SSI in the inpatient setting, but the majority of wound infections (up to 84%) develop in the interval following hospital discharge and prior to routine follow-up. The importance of the outpatient setting makes transitional care coordination an important focus in the management of SSI. Patient-centered interventions to improve transitional care for surgical patients are absent from the literature and routine practice but hav the potential to stem the burden of SSI and readmissions in this complex patient population. We will address this gap with a patient-centered, outpatient wound surveillance program using Smartphone-digital photography designed to promote early recognition of SSI following discharge. Evaluations of personal digital assistant (PDA) and touch-based technological interfaces for older adults have produced very encouraging results. Moreover, smartphone data plans permit the transmission of information without an Internet connection or WiFi hotspot. We hypothesize that (1) photo and in-person assessments of wounds are equivalent in detecting wound complications, (2) with proper training and support, patients/caregivers will be capable of routinely utilizing smartphone technology to photograph and transfer digital pictures of their postoperative wounds, and (3) a well-designed outpatient wound surveillance program can empower patients to monitor their wounds, lead to early diagnosis of wound complications, and prevent readmission and potentially life threatening complications. We focus on vascular surgery because this population has the highest readmission rate among surgical specialties, most commonly for SSI. Vascular surgery also has the highest projected demand growth among medical specialties (31% by 2025) after adjusting for expanded coverage under the Patient Protection and Affordable Care Act. In Aim 1, we determine whether health care providers/surgeons can differentiate between infected and normally healing wounds using a Smartphone digital photograph and a standardized evaluation adapted from the CDC. In Aim 2, we design and evaluate the three major components of a patient centered Outpatient Wound Surveillance Program (OWSP): A) Application (App) Design for a Web-based Smartphone, B) Training Module Design for patients or caregivers to photograph and transmit Smartphone images of their postoperative wounds, and C) Create methodology for assimilation and review of data by a surgical service. In Aim 3, we combine the three components and pilot test the full patient centered OWSP with a targeted enrollment of 40 patients. Our goal in completing this application is to be prepared to implement the intervention as a multicenter, randomized controlled trial. Our work will ultimately improve transitional care for surgical patients and connect patient-centeredness to post-operative care.

描述(申请人提供)：外科部位感染(SSI)是外科患者最常见的医院感染，占术后并发症的38%。SSI和其他伤口并发症会给相当数量的患者及其家人带来身体和精神上的压力，并可能导致再次入院、再次手术、肢体丧失或死亡。伤口并发症也增加了医疗费用，我们发现SSI是外科患者计划外再次住院的主要原因，可能是可以预防的。如果在早期诊断，SSI可以在门诊环境下使用口服抗生素和伤口护理进行治疗，从而排除了重新入院、静脉注射抗生素和再干预的需要。然而，患者很少认识到早期伤口感染，而且经常出现晚期感染，需要加强治疗和再次住院。在住院环境中采取了预防SSI的干预措施，但大多数伤口感染(高达84%)发生在出院后和常规随访之前的间隔时间。门诊设置的重要性使得过渡期护理协调成为SSI管理中的一个重要焦点。文献和常规实践中没有以患者为中心的干预措施来改善外科患者的过渡期护理，但有可能在这个复杂的患者群体中减少SSI和再入院的负担。我们将通过以患者为中心的门诊伤口监测计划来解决这一差距，该计划使用智能手机数码摄影，旨在促进出院后SSI的早期识别。针对老年人的个人数字助理(PDA)和触摸式技术界面的评估产生了非常令人鼓舞的结果。此外，智能手机数据计划允许在没有互联网连接或WiFi热点的情况下传输信息。我们假设(1)对伤口的照片和面对面评估在检测伤口并发症方面是同等的，(2)通过适当的培训和支持，患者/护理者将能够常规地利用智能手机技术拍摄和传输他们术后伤口的数字照片，以及(3)设计良好的门诊伤口监测程序可以使患者能够监测他们的伤口，导致伤口并发症的早期诊断，并防止再次入院和潜在的危及生命的并发症。我们专注于血管外科，因为在外科专科中，这一群体的再住院率最高，最常见的是SSI。在根据《患者保护和平价医疗法案》(Patient Protection And Affordable Care Act)扩大覆盖范围进行调整后，血管外科也是医疗专业中需求增长最快的(到2025年增长31%)。在目标1中，我们确定卫生保健提供者/外科医生是否可以使用智能手机数字照片和CDC改编的标准化评估来区分感染伤口和正常愈合的伤口。在目标2中，我们设计和评估了以患者为中心的门诊伤口监测计划(OWSP)的三个主要组成部分：A)基于Web的智能手机的应用程序(App)设计；B)为患者或护理人员拍摄和传输其术后伤口的智能手机图像的培训模块设计；以及C)创建用于外科服务数据的同化和审查的方法。在目标3中，我们结合了这三个组成部分，并对以患者为中心的OWSP进行了试点测试，有针对性地招募了40名患者。我们完成这项申请的目标是准备将干预作为一项多中心随机对照试验来实施。我们的工作最终将改善手术患者的过渡护理，并将以患者为中心与术后护理联系起来。