Patient-Centered Postoperative Wound Surveillance Using Current Technology

描述（申请人提供）：手术部位感染（Surgical site infection， SSI）是外科患者最常见的院内感染，占术后并发症的38%。SSI和其他伤口并发症会给大量患者及其家属带来身体和情绪压力，并可能导致再入院、再手术、肢体丧失或死亡。伤口并发症也会增加医疗费用，我们发现SSI是手术患者计划外的、潜在可预防的再入院的主要原因。如果在早期诊断，SSI可以在门诊通过口服抗生素和伤口护理进行治疗，排除再入院、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，经常出现晚期感染，需要强化治疗和再次住院。已经采取了干预措施来预防住院环境中的伤口感染，但大多数伤口感染（高达84%）是在出院后和常规随访之前发生的。门诊环境的重要性使得过渡护理协调成为SSI管理的一个重要焦点。以患者为中心的干预措施，以改善手术患者的过渡护理，在文献和常规实践中都是缺失的，但在这一复杂的患者群体中，有可能遏制SSI和再入院的负担。我们将通过一个以患者为中心的门诊伤口监测项目来解决这一问题，该项目使用智能手机数码摄影技术，旨在促进出院后对SSI的早期识别。针对老年人的个人数字助理（PDA）和基于触摸的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)伤口的照片和现场评估在发现伤口并发症方面是等效的；(2)通过适当的培训和支持，患者/护理人员将能够常规地利用智能手机技术拍摄和传输其术后伤口的数字照片；(3)设计良好的门诊伤口监测程序可以使患者监测他们的伤口，从而早期诊断伤口并发症。防止再入院和潜在的危及生命的并发症。我们关注血管外科，因为这一人群在外科专科中再入院率最高，最常见的是SSI。根据《患者保护和平价医疗法案》（Patient Protection and Affordable Care Act）扩大的覆盖范围进行调整后，血管外科在医疗专业中预计需求增长最高（到2025年将达到31%）。在目标1中，我们确定医疗保健提供者/外科医生是否可以使用智能手机数码照片和CDC改编的标准化评估来区分感染和正常愈合的伤口。在目标2中，我们设计并评估了以患者为中心的门诊伤口监测项目（OWSP）的三个主要组成部分：a)基于网络的智能手机应用程序（App）设计，B)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)创建外科服务同化和审查数据的方法。在Aim 3中，我们结合了这三个组成部分，并对40名患者进行了以患者为中心的全面OWSP试点测试。我们完成这一申请的目的是准备实施多中心、随机对照试验的干预措施。我们的工作将最终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。

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.