The project team and Scientific Board worked together to synthesize the information gathered during the HTA process in order to provide a set of ten recommendations for utilizing PGHD for SSI monitoring and surveillance that incorporates input from experts and other key stakeholders, and identifies open issues on post-operative use of PGHD for which additional evidence and experience are needed to optimize application of those data for clinical and public health purposes. This work identified guidance and recommendations in several areas, including practice, research, and public health surveillance to address CDC’s clinical and public health priorities. The preliminary findings that led to the ten recommendations included here were presented at the PSAG Workshop, and subsequently refined through a series of editorial cycles with the Project Team and Scientific Board. The recommendations were further refined through feedback obtained from presentations to three national surgical organizations: the Surgical Infection Society (SIS), the National Surgical Quality Improvement Program (NSQIP), and the American College of Surgeons (ACS). Feedback was solicited directly after symposia presented at the annual meetings of each of these organizations and incorporated into this draft HTA report. Further revision was conducted based on the feedback from CDC scientific staff.
The following ten recommendations incorporate evidence from key informant interviews, PSAG feedback, literature review, and market/technology scan, and the general literature pertaining to each individual topic area. In areas where there is sufficient evidence, the recommendations propose practice guidance. In areas where there are gaps, the goal is to propose recommendations for a research agenda and to identify high priority research questions based on both impact and feasibility.
The recommendations, grouped into five categories, are as follows:
Development Recommendations
Recommendation 1: Tools and programs that use PGHD captured via mHealth for SSI surveillance should be designed and implemented with direct involvement of core beneficiaries and stakeholders. This includes patients, providers, and administrative staff who are the primary users of mHealth tools and programs.
Recommendation 2: Best practices and standards for privacy and security of PGHD captured via mHealth for SSI surveillance should be established and rigorously followed. Protection of patient-generated health data presents unique challenges due to its nature as data originating outside of the healthcare environment, and as data that “belongs” to patients.
Workflow Recommendations
Recommendation 3: Design of tools and programs that use PGHD captured via mHealth for SSI surveillance should address the new complexities presented to workflow, IT integration and communication. This includes provider and administrative staff workflows inside, and potentially outside, the clinic as well as integration with existing health IT infrastructures.
Recommendation 4: Design of tools and programs that use PGHD captured via mHealth for SSI surveillance should acknowledge and account for the work performed by patients outside the healthcare setting. Collection and reporting of patient-generated health data by patients who are most likely in a post-surgical state entails additional burdens on time and energy.
Community of Practice Recommendations
Recommendation 5: To expedite the generation of evidence for using PGHD captured via mHealth for SSI surveillance, a Community of Practice (CoP) should be established, including participation from the full range of stakeholders. This CoP would continue collaboration to identify valuable activities to advance knowledge and practice, support efficient dissemination of research results, support the development of methods for the implementation of PGHD captured via mHealth for SSI surveillance, and enable practitioners and researchers to draw on the knowledge and experience of leaders in the field.
Recommendation 6: For continued advancement of PGHD captured via mHealth for SSI surveillance, researchers and health systems should look to other disciplines and non-surgical specialties where technology and programs for mHealth and PGHD are in a more advanced state, including in teledermatology, burn care, and chronic wound care.
Definition of SSI Recommendations
Recommendation 7: Research on PGHD captured via mHealth for SSI surveillance should include the development of a database of patient-generated post-operative wound photos. Such a database would make available for research a robust data set for the examination of post-operative would health and the range of post-operative wound appearance.
Recommendation 8: Data generated through PGHD captured via mHealth for SSI surveillance should be leveraged to better characterize the natural history of SSI and inform a review of current clinical practices and surveillance standards for identifying and diagnosing SSI.
Evaluation Recommendations
Recommendation 9: Implementation Science frameworks should be used to evaluate the success of programs that utilize PGHD captured via mHealth for SSI surveillance. Rigorous evaluation supports program sustainability, scalability, and replicability, and increases the likelihood of success of future programs. Evaluation should support deployment of these programs to ensure equitable health care access and cost arrangements.
Recommendation 10: Metrics used to assess core outcomes of PGHD captured via mHealth for SSI surveillance should align with value propositions held by stakeholders, including patients, providers, administrators, payers, researchers, and public health. Such metrics include patient satisfaction/experience, health outcomes, healthcare utilization, and public health data utilization.