A. R. Scott1,2, G. K. Low1, A. D. Naik1,2, D. H. Berger1,2, J. W. Suliburk1 1Baylor College Of Medicine,Houston, TX, USA 2VA Center For Innovations In Quality, Effectiveness And Safety,Houston, TX, USA
Introduction:
Limited communication and care coordination following discharge may contribute to surgical complications. Smartphone applications (“apps”) offer a new mechanism for communicating with patients and directing their care. It is unclear, however, whether or not patients are willing and able to use apps as part of their surgical care. To better understand patient factors which could prevent app use in a surgical setting, we performed a feasibility study on an app designed to facilitate self-care following colorectal surgery.
Methods:
This was a prospective mixed-methods feasibility study performed at an urban public safety net hospital. Following colorectal surgery, patients were approached for enrollment and offered a smartphone app which uses previously validated content to provide recommendations based on symptoms. Patients were asked to use the app daily for 14 days after discharge. Demographics and usability data were collected at enrollment. The System Usability Scale (SUS) was used to measure usability. The SUS was repeated at follow up and then we performed a structured interview covering domains such as ease of use, willingness to use, and utility of use. Chart and app log review identified phone calls and ER visits related to surgery.
Results:
We screened 75 patients, enrolled 14 (19%), and completed follow up interviews with 10 (13%). Reasons for non-enrollment included: lack of a suitable device (16 patients, 21%), willingness to participate (14, 19%), language barriers (12, 16%), inclusion criteria (11, 15%), and other reasons (8, 11%). The unplanned ER visit rate was 43% (6/14), with a 14% (2/14) readmission rate. The app addressed 67% (4/6) of the presenting complaints in the ER, but no patients reported those complaints in the app. The app was used once or not at all by 4/14 patients (29%); the remaining 10 (71%) used it a median of 7 times (6-13). SUS scores were >90th percentile at first use (raw score 94, IQR 86-96) and follow up (88, 83-95). Four patients who were interviewed (40%) reported daily app use. Feeling ill was the most common (3/6, 50%) reason for less frequent use. All 10 patients interviewed reported being able to fill out the app themselves, 9 denied difficult or confusing questions, 8 felt the app fit into their daily routine, and 1 felt there were too many questions. Six felt the app’s recommendations could be trusted, 3 weren’t sure, and 1 did not trust the app.
Conclusion:
Smartphone based interventions have the potential to improve care coordination and patient perceptions of communication. Patient barriers to app use include device availability, interest, compliance when feeling ill, and incomplete or inaccurate symptom reporting. Use patterns in this study fell short of goals outlined at enrollment, suggesting the need for highly engaging apps. Further study is needed to find ways to overcome these barriers as well as methods of integrating apps into surgical care pathways.