Conference PaperPDF Available

Provider Needs Assessment for mPOWEr: a Mobile tool for Post-Operative Wound Evaluation

Authors:

Abstract

Current provider workflows do not effectively capture surgical site infections (SSIs) occurring after hospital discharge. We conducted a needs assessment among providers to guide development of a patient-centered mobile tool to facilitate SSI surveillance at home. We identified concerns and prioritized features based on the survey. Despite concern about the potential for increased workload, 92% of providers were likely to adopt the tool.
A preview of the PDF is not available

Supplementary resource (1)

... Both stakeholder groups perceive there to be an opportunity for a mobile health application to address concerns with current ad hoc practices, help patients transition home from the hospital, improve patient-provider communication, and identify surgical complications earlier. 29,30 However, this post-acute care setting poses special challenges, because its workflows (eg, triage) exemplify the provider-centric nature of most healthcare systems. ...
... Providers were surveyed through an anonymous web-based survey, the results of which are described elsewhere. 29 The second group of patients and providers were interviewed as part of the design refinement. This group of patients were patient advocates (PAs) who had previously volunteered to advise the hospital on matters affecting patients (PA, n ¼ 6). ...
Article
Full-text available
Objective The proposed Meaningful Use Stage 3 recommendations require healthcare providers to accept patient-generated health data (PGHD) by 2017. Yet, we know little about the tensions that arise in supporting the needs of both patients and providers in this context. We sought to examine these tensions when designing a novel, patient-centered technology – mobile Post-Operative Wound Evaluator (mPOWEr) – that uses PGHD for post-discharge surgical wound monitoring. Materials and Methods As part of the iterative design process of mPOWEr, we conducted semistructured interviews and think-aloud sessions using mockups with surgical patients and providers. We asked participants how mPOWEr could enhance the current post-discharge process for surgical patients, then used grounded theory to develop themes related to conflicts and agreements between patients and providers. Results We identified four areas of agreement: providing contextual metadata, accessible and actionable data presentation, building on existing sociotechnical systems, and process transparency. We identified six areas of conflict, with patients preferring: more flexibility in data input, frequent data transfer, text-based communication, patient input in provider response prioritization, timely and reliable provider responses, and definitive diagnoses. Discussion We present design implications and potential solutions to the identified conflicts for each theme, illustrated using our work on mPOWEr. Our experience highlights the importance of bringing a variety of stakeholders, including patients, into the design process for PGHD applications. Conclusion We have identified critical barriers to integrating PGHD into clinical care and describe design implications to help address these barriers. Our work informs future efforts to ensure the smooth integration of essential PGHD into clinical practice.
... Recent studies suggest that inadequate post-discharge communication and untimely, infrequent follow-up contribute to poorer outcomes (e.g. readmission) [14], [15]. Mobile health (mHealth) may present an opportunity to improve the identification and management of post-discharge SSI. ...
... due to anxiety related to initial identification of SSI including unsatisfactory attempts to contact providers). In our previous work, providers identified many of the same systemic problems, including challenges communicating prior to scheduled follow-up visits [14]. Historically, patients have not been engaged to prospectively monitor and communicate with providers about their surgical wounds following discharge; typically, surveillance has been passive, retrospective and under the purview of infection control [22]. ...
Article
Full-text available
Background Post-discharge surgical site infections (SSI) are a major source of morbidity, expense and anxiety for patients. However, patient perceptions about barriers experienced while seeking care for post-discharge SSI have not been assessed in depth. We explored patient experience of SSI and openness to a mobile health (mHealth) wound monitoring “app” as a novel solution to address this problem. Methods Mixed method design with semi-structured interviews and surveys. Participants were patients who had post-discharge surgical wound complications after undergoing operations with high risk of SSI, including open colorectal or ventral hernia repair surgery. The study was conducted at two affiliated teaching hospitals, including an academic medical center and a level 1 trauma center. Results From interviews with 13 patients, we identified 3 major challenges that impact patients' ability to manage post-discharge surgical wound complications, including required knowledge for wound monitoring from discharge teaching, self-efficacy for wound monitoring at home, and accessible communication with their providers about wound concerns. Patients found an mHealth wound monitoring application highly acceptable and articulated its potential to provide more frequent, thorough, and convenient follow-up that could reduce post-discharge anxiety compared to the current practice. Major concerns with mHealth wound monitoring were lack of timely response from providers and inaccessibility due to either lack of an appropriate device or usability challenges. Conclusions Our findings reveal gaps and frustrations with post-discharge care after surgery which could negatively impact clinical outcomes and quality of life. To address these issues, we are developing mPOWEr, a patient-centered mHealth wound monitoring application for patients and providers to collaboratively bridge the care transition between hospital and home.
... Additionally, recent studies suggest that inadequate post-discharge communication, care fragmentation, and, untimely, infrequent follow-up contribute to these poorer outcomes. [14][15][16] As providers and hospitals seek to address the gap between discharge and follow-up visits, many are turning to technological approaches made possible by the increasing prevalence of smartphones, coupled with patients' increasing interest in tracking their own health. [17][18][19] Indeed, patients and providers have both expressed interest in using mobile health tools to facilitate improved post-discharge wound tracking, and several small trials have shown feasibility of mobile health tools for wound monitoring. ...
Article
Full-text available
Background: Postoperative surgical site infections (SSI) are common and costly. Most occur post-discharge, and may result in potentially preventable readmission and/or unnecessary urgent evaluation. Mobile health approaches incorporating patient-generated wound photos are being implemented in an attempt to optimize triage and management. We assessed how adding wound photos to existing data sources modifies provider decision-making. Study design: Web-based simulation survey using convenience sample of providers with expertise in surgical infections. Participants viewed a range of scenarios including surgical history, physical exam and description of wound appearance. All participants reported SSI diagnosis, diagnostic confidence, and management recommendations (main outcomes), first without, and then with accompanying wound photos. At each step, participants ranked the most important features contributing to their decision. Results: Eighty-three participants completed a median of 5 scenarios (IQR 4-7). Most participants were physicians in academic surgical specialties (N=70, 84%). Addition of photos improved overall diagnostic accuracy from 67% to 76% (p<0.001), and increased specificity from 77% to 92% (p<0.001) but did not significantly increase sensitivity (55% to 65%, p=0.16). Photos increased mean confidence in diagnosis from 5.9/10 to 7.4/10 (p<0.001). Overtreatment recommendations decreased from 48% to 16% (p<0.001) while undertreatment did not change (28% to 23%, p=0.20) with addition of photos. Conclusions: Addition of wound photos to existing data as available via chart review and telephone consultation with patients significantly improved diagnostic accuracy and confidence, and prevented proposed overtreatment in scenarios without SSI. Post-discharge mobile health technologies have the potential to facilitate patient-centered care, decrease costs, and improve clinical outcomes.
Article
Many current mobile health applications ("apps") and most previous research have been directed at management of chronic illnesses. However, little is known about patient preferences and design considerations for apps intended to help in a post-acute setting. Our team is developing an mHealth platform to engage patients in wound tracking to identify and manage surgical site infections (SSI) after hospital discharge. Post-discharge SSIs are a major source of morbidity and expense, and occur at a critical care transition when patients are physically and emotionally stressed. Through interviews with surgical patients who experienced SSI, we derived design considerations for such a post-acute care app. Key design qualities include: meeting basic accessibility, usability and security needs; encouraging patient-centeredness; facilitating better, more predictable communication; and supporting personalized management by providers. We illustrate our application of these guiding design considerations and propose a new framework for mHealth design based on illness duration and intensity.
Conference Paper
Full-text available
Many current mobile health applications (“apps”) and most previous research have been directed at management of chronic illnesses. However, little is known about patient preferences and design considerations for apps intended to help in a post-acute setting. Our team is developing an mHealth platform to engage patients in wound tracking to identify and manage surgical site infections (SSI) after hospital discharge. Post-discharge SSIs are a major source of morbidity and expense, and occur at a critical care transition when patients are physically and emotionally stressed. Through interviews with surgical patients who experienced SSI, we derived design considerations for such a post-acute care app. Key design qualities include: meeting basic accessibility, usability and security needs; encouraging patient-centeredness; facilitating better, more predictable communication; and supporting personalized management by providers. We illustrate our application of these guiding design considerations and propose a new framework for mHealth design based on illness duration and intensity.
ResearchGate has not been able to resolve any references for this publication.