This news release reports on a feasibility study of using a smartphone app to detect post-surgical infections that patients might not recognize on their own. The news release does an exemplary job of discussing the need for such supports as patient training and dedicated staff to monitor uploaded images and points out that the study lacks a cost analysis. However, the headline overreaches when it states that the app “can reduce readmissions and improve patient care,” since this two-week study of 40 patients wasn’t geared to do that.
Post-surgical infections can cause pain, poor wound healing, and severe problems including death, research has showed. The release noted they’re the most expensive hospital-acquired infection, costing an average of nearly $30,000 per wound-related readmission and an estimated $3-$10 billion annually. While smartphone apps might improve the ability of staff to monitor surgical wounds, news releases should point out the need to invest in a support structure — such as staff to train patients and monitor data — and should refrain from stating benefits that haven’t been demonstrated.
The news release addresses the overall cost of post-surgical infections and the potential for cost savings using the monitoring app. The lead author of the study is quoted saying that preventing readmissions due to infection could lead to “significant savings to the health system,” and the release notes that “capturing specific numbers related to cost-savings was not part of this study.”
The news release helpfully states that providers have to pay for training and in some cases smartphones for patients, and pay staff to monitor the data in a “dedicated transitional care program.”
The the app itself is free for patients to download, which isn’t explicitly mentioned. There’s no mention of whether hospitals have to pay to use it.
The news release reports “an overall data submission rate of 90.2 percent among participants, and submissions were reviewed within an average of 9.7 hours. During the study, seven wound complications were detected and one false negative was found.”
But with no control group and no long term outcomes studied, it’s likely the benefits of the app are much more modest than these numbers suggest.
Harms aren’t explored. The app mentions that there was one false negative result among the 40 patients studied, but doesn’t explain why this happened or what the consequence was.
The release should have pointed out clearly that the study was not set up to test a hypothesis or look for any benefits or harms.
It mentions that the study involved 40 vascular surgery patients over a two-week period, but does not acknowledge the weaknesses of such a small study and the fact that it did not compare those patients to a group who did not use the app. It also doesn’t mention that the study authors acknowledge more research is needed with non-white patients.
The news release does win some points for discussing in detail the need for hospitals to address the fact that not every patient has a smartphone or knows how to upload images to an app.
The news release states that support came from the Agency for Healthcare Research and Quality and that lead author Rebecca L. Gunter, MD, is supported by the National Institutes of Health.
The study mentions patients whose infections are detected during routine follow-up exams, but doesn’t describe what steps are currently taken to catch post-operative infections. Do hospitals educate patients to recognize infections? Do staff follow up in any way, perhaps with phone calls? Those questions aren’t answered.
There’s no discussion of how many hospitals are using this app.
The release did discuss some of the practical aspects of implementation but nothing about whether such an app is available or if insurance will pay for any of the costs involved.
The news release provides this quote from the study: “We have demonstrated that a population of complex and high-risk patients, many of whom are older adults and novice smartphone users, can complete this protocol with high fidelity and satisfaction.”
Wound management by “telemedicine” is not unique but the use of cell phones is innovative enough to pass on this criteria. The study showed that patients who are given a phone and taught to use it can send pictures of their wounds.
The headline overreaches when it states that the app “can reduce readmissions and improve patient care.” The study’s conclusion is far more nuanced: “Preliminary results indicate the ability to detect and intervene on wound complications.”
Systematic, Criteria-Driven
Monday at #ADA2021, an infectious disease epidemiologist, a journalist, and a researcher shared perspectives on communication of risk in the era of COVID-19: http://ow.ly/ROfR30rMeE7 @AstleyCM @garyschwitzer @berthahidalgo @ADA_DiabetesPro
Shoutouts to @susan_bewley @drkevinknopf @MichaelBaum11 in this call for more than fawning coverage from press releases for these kinds of stories.
Also, linked history inside goes back 5 years just on Grail apparently trying to become Holy Grail. https://twitter.com/garyschwitzer/status/1408849696416841731
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