一款用于结直肠癌手术后出院早期随访的智能手机应用程序的开发与验证
Developing and validation of a smartphone app for post-discharge early follow-up after colorectal cancer surgeries.
作者信息
Kupper Bruna Elisa Catin, Bernardon Elaine Cordeiro, Antunes Camila Forni, Martos Natalia Martinez, Sacomani Carlos Alberto Ricetto, Azevedo Mauricio, Adolfi Junior Mario Sergio, Bezerra Tiago Santoro, Marques Tomas Mansur Duarte de Miranda, Stevanato Filho Paulo Roberto, Takahashi Renata Mayumi, Nakagawa Wilson Toshihiko, Lopes Ademar, Aguiar Samuel
机构信息
Colorectal Cancer Reference Center, AC Camargo Cancer Center, Sao Paulo, Brazil.
Value Based Office, AC Camargo Cancer Center, Sao Paulo, Brazil.
出版信息
Digit Health. 2024 Oct 24;10:20552076241292389. doi: 10.1177/20552076241292389. eCollection 2024 Jan-Dec.
BACKGROUND
Colorectal surgeries are complex procedures associated with high rates of complications and hospital readmission.
OBJECTIVE
This study aimed to develop an electronic post-discharge follow-up plan to remotely monitor patients' symptoms in the postoperative period of colorectal surgeries and evaluate the outcomes of emergency department visits and the rate of severe complications within 15 days after hospital discharge.
DESIGN
We developed a digital tool capable of remotely assessing symptoms that could indicate complications related to colorectal surgical procedures and directing early management. This project was divided into two stages. The first was platform development with an algorithm for identifying symptoms and directing conduct, and the second was clinical validation of the program and evaluation of patient's experience. Patients who underwent elective oncological colorectal surgery were invited to participate in this study. We used commercial software (CleverCare) that was adjusted according to the clinical algorithm developed in this study, predicting complications and directing conduct with minimal human intervention using a Chatbot with Natural Language Processing (NPL) and artificial intelligence.
RESULTS
We planned three Interim Analyses to evaluate the outcomes of complications, referrals to the Emergency Department (ED), ED visits, adherence, and patient satisfaction. After each analysis, specialists validated the changes before implementation. A total of 92 eligible participants agreed to participate in the study. The ability to detect complications increased with each adjustment phase, and after the third and last phase, the digital solution identified 3(4.8%) real complications, with a sensitivity of 75%, specificity of 83%, accuracy of 82%, positive predictive value of 27%, and negative predictive value of 97%. Complete adherence to the monitoring program was 83.7% with an NPS score of 94 in the last evaluation phase.
CONCLUSION
The digital platform is safe with high adherence rates and good patient acceptance.
背景
结直肠手术是复杂的手术，并发症发生率和医院再入院率都很高。
目的
本研究旨在制定一项出院后电子随访计划，以远程监测结直肠手术后患者的症状，并评估出院后15天内急诊科就诊结果和严重并发症发生率。
设计
我们开发了一种数字工具，能够远程评估可能表明与结直肠手术相关并发症的症状，并指导早期管理。该项目分为两个阶段。第一阶段是平台开发，采用一种识别症状和指导行为的算法；第二阶段是对该程序进行临床验证并评估患者体验。邀请接受择期肿瘤性结直肠手术的患者参与本研究。我们使用了商业软件（CleverCare），该软件根据本研究开发的临床算法进行了调整，通过具有自然语言处理（NPL）和人工智能的聊天机器人，以最少的人工干预预测并发症并指导行为。
结果
我们计划进行三次中期分析，以评估并发症结果、转诊至急诊科（ED）、ED就诊、依从性和患者满意度。每次分析后，专家在实施前对更改进行了验证。共有92名符合条件的参与者同意参与该研究。随着每个调整阶段的进行，检测并发症的能力有所提高，在第三个也是最后一个阶段之后，数字解决方案识别出3例（4.8%）实际并发症，灵敏度为75%，特异度为83%，准确度为82%，阳性预测值为27%，阴性预测值为97%。在最后一个评估阶段完全遵守监测计划的比例为83.7%，净推荐值（NPS）得分为94。
结论
该数字平台安全，依从率高，患者接受度良好。
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