Patient Perspectives on Post-Discharge Surgical Site Infections: Towards a Patient-Centered Mobile Health Solution

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.

研究背景
术后手术部位感染（Surgical Site Infections，SSI）是导致患者罹患疾病、产生高额医疗成本并引发焦虑的主要因素之一。然而，目前尚未针对患者在寻求术后手术部位感染诊疗时所遭遇的各类障碍的认知展开深入研究。本研究旨在探究患者术后手术部位感染的就医体验，以及其对移动医疗（mobile health，mHealth）伤口监测应用程序这一新型解决方案的接受意愿。

研究方法
本研究采用混合研究设计，结合半结构化访谈与问卷调查。研究对象为曾接受结直肠开放式手术或腹疝修补术等手术部位感染高风险术式、术后出院后出现手术伤口并发症的患者。本研究在两家直属教学医院开展，分别为一所学术医疗中心与一所一级创伤中心。

研究结果
本研究通过对13名患者的访谈，总结出影响患者术后出院伤口并发症管理能力的三大核心挑战：出院宣教中关于伤口监测的必备知识储备不足、居家伤口监测的自我效能感缺失，以及与医护人员就伤口相关问题进行便捷沟通的障碍。患者对移动医疗伤口监测应用程序表现出极高的接受度，并指出相较于当前诊疗常规，该应用可提供更频繁、全面且便捷的随访服务，从而缓解患者出院后的焦虑情绪。针对该类移动医疗伤口监测工具的主要顾虑包括医护人员响应不及时，以及因缺乏适配设备或使用难度较高导致的工具不可用问题。

研究结论
本研究结果显示，术后出院护理存在诸多不足与痛点，这些问题可能对临床结局与患者生活质量产生负面影响。为解决上述问题，我们正在开发一款以患者为中心的移动医疗伤口监测应用程序mPOWEr，该工具可助力患者与医护人员协同衔接院内与居家的护理过渡阶段。