Surgical Human Resources for Health
Community health workers and smartphones for the detection of surgical site infections in rural Haiti: a pilot study Alexi Matousek, Ken Paik, Eric Winkler, Jennifer Denike, Stephen R Addington, Chauvet Exe, Rodolphe R E Jean Louis, Robert Riviello
Abstract Background Absence of outcome data is a barrier to quality improvement in resource poor settings. To address this challenge, we set out to determine whether follow up for surgical site infections (SSIs) using community health workers (CHWs) and smartphones is feasible in rural Haiti. Methods In this pilot study, all patients from a specific mountain region who received an operation between March 10, and July 1, 2014, at Hôpital Albert Schweitzer in rural Haiti were eligible for inclusion. Patients or guardians of minors were approached for consent. We designed a smartphone application to enable CHWs to screen for SSIs during home visits by administering a questionnaire, obtaining GPS data, and submitting a photograph of an incision. We selected and trained CHWs to use the smartphone application and compensated them based on performance. CHWs completed home visits for 30 days after an operation for all participants. Surgeons examined all participants within 24 h after the second CHW home visit. Primary outcomes included the number of participants completing 30-day follow-up and home visits made on time. Secondary outcomes included the quality of the photographs and the agreement between surgeons and CHWs on the diagnosis of SSI. The Partners Healthcare institutional review board and the Ethics Committee at Hôpital Albert Schweitzer approved the study protocol. Findings Five CHWs completed 30-day follow up for 37 of 39 participants (94·9%) and completed 107 of 117 home visits on time (91·5%). High quality photographs were submitted for 101 of 117 visits (86·3%). Surgeons and CHWs agreed on the diagnosis of SSI in 28 of 33 cases (84·8%).
Published Online April 27, 2015 Poster 50 The Center for Surgery and Public Health, Brigham and Women’s Hospital, Boston, MA, USA (A Matousek MD, S R Addington BS, R Riviello MD); Sana, Massachusetts Institute of Technology, Cambridge, MA, USA (K E Paik MD, E Winkler BS); and Hôpital Albert Schweitzer, Gabon, Haiti (J Denike BA, C Exe MD, R R E Jean-Louis MD) Correspondence to: Dr Alexi Matousek, Brigham and Women’s Hospital Surgery, Boston, MA 02115, USA [email protected]
Interpretation Outpatient follow up for SSIs with CHWs and smartphones is feasible in rural Haiti. Further validation of the programme needs to be done before widespread adoption or advocating for task shifting post-operative follow up to CHWs. Funding Partners Healthcare, Children’s Hospital Boston, and Swiss Bündner Partnerschaft Hôpital Albert Schweitzer Haiti. Contributors AM designed the study, collected the data, did the analysis, and wrote the first draft of the Abstract. KP designed the mobile health application and assisted with data interpretation. EW designed and wrote the mobile health application and collected and analysed the data. JD supervised the community health workers and collected study data. SRA did the literature search and wrote portions of the Abstract. CE and RREJL provided guidance, did the operations, assessed the patients, and collected study data. RR provided guidance on the study design and edited the Abstract. All authors approved the final version of the Abstract for publication. Declaration of interests We declare no competing interests. Acknowledgments We are indebted to the community health workers Milien Milotes, Darline Civil, Rodrigue Civil, Vildort Dorsainvil, Junior Rincher, Mackendy Tanilus, and Edouard Wisnel, and to Mantaniel Filuis for coordination within the rural mountain community.
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Community health workers and smartphones for the detection of surgical site infections in rural Haiti: a pilot study Alexi Matousek, Ken Paik, Eric Winkler, Jennifer Denike, Stephen R Addington, Chauvet Exe, Rodolphe R E Jean Louis, Robert Riviello
Abstract Background Absence of outcome data is a barrier to quality improvement in resource poor settings. To address this challenge, we set out to determine whether follow up for surgical site infections (SSIs) using community health workers (CHWs) and smartphones is feasible in rural Haiti. Methods In this pilot study, all patients from a specific mountain region who received an operation between March 10, and July 1, 2014, at Hôpital Albert Schweitzer in rural Haiti were eligible for inclusion. Patients or guardians of minors were approached for consent. We designed a smartphone application to enable CHWs to screen for SSIs during home visits by administering a questionnaire, obtaining GPS data, and submitting a photograph of an incision. We selected and trained CHWs to use the smartphone application and compensated them based on performance. CHWs completed home visits for 30 days after an operation for all participants. Surgeons examined all participants within 24 h after the second CHW home visit. Primary outcomes included the number of participants completing 30-day follow-up and home visits made on time. Secondary outcomes included the quality of the photographs and the agreement between surgeons and CHWs on the diagnosis of SSI. The Partners Healthcare institutional review board and the Ethics Committee at Hôpital Albert Schweitzer approved the study protocol. Findings Five CHWs completed 30-day follow up for 37 of 39 participants (94·9%) and completed 107 of 117 home visits on time (91·5%). High quality photographs were submitted for 101 of 117 visits (86·3%). Surgeons and CHWs agreed on the diagnosis of SSI in 28 of 33 cases (84·8%).
Published Online April 27, 2015 Poster 50 The Center for Surgery and Public Health, Brigham and Women’s Hospital, Boston, MA, USA (A Matousek MD, S R Addington BS, R Riviello MD); Sana, Massachusetts Institute of Technology, Cambridge, MA, USA (K E Paik MD, E Winkler BS); and Hôpital Albert Schweitzer, Gabon, Haiti (J Denike BA, C Exe MD, R R E Jean-Louis MD) Correspondence to: Dr Alexi Matousek, Brigham and Women’s Hospital Surgery, Boston, MA 02115, USA [email protected]
Interpretation Outpatient follow up for SSIs with CHWs and smartphones is feasible in rural Haiti. Further validation of the programme needs to be done before widespread adoption or advocating for task shifting post-operative follow up to CHWs. Funding Partners Healthcare, Children’s Hospital Boston, and Swiss Bündner Partnerschaft Hôpital Albert Schweitzer Haiti. Contributors AM designed the study, collected the data, did the analysis, and wrote the first draft of the Abstract. KP designed the mobile health application and assisted with data interpretation. EW designed and wrote the mobile health application and collected and analysed the data. JD supervised the community health workers and collected study data. SRA did the literature search and wrote portions of the Abstract. CE and RREJL provided guidance, did the operations, assessed the patients, and collected study data. RR provided guidance on the study design and edited the Abstract. All authors approved the final version of the Abstract for publication. Declaration of interests We declare no competing interests. Acknowledgments We are indebted to the community health workers Milien Milotes, Darline Civil, Rodrigue Civil, Vildort Dorsainvil, Junior Rincher, Mackendy Tanilus, and Edouard Wisnel, and to Mantaniel Filuis for coordination within the rural mountain community.
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