Assessing feasibility and acceptability of a multifaceted EHR-integrated mobile health intervention following radical cystectomy

About This Grant

Project Summary/Abstract One in five patients are readmitted following major cancer surgery in the United States. These readmissions are associated with increased morbidity and mortality, lead to care fragmentation, delay adjuvant treatments, and result in substantial costs to the healthcare system. A wide spectrum of interventions have attempted to minimize this burden, yet readmissions following these procedures have remained stagnant. In large part, this can be attributed to the fact that the drivers of these readmisisons are multifactorial, arising from the interplay between a complex surgery and an older patient population with multiple medical problems. This concept is clearly evident among bladder cancer patients undergoing cystectomy where readmissions have plateaued at 25% for decades, making this the ideal population to study potential interventions aimed at decreasing readmission burden. Prior interventions have failed to reduce readmissions because they were broad and non-specific for the cystectomy population and limited by low intensity, sub-optimal timing or duration, were resource intensive, and failed to engage the spectrum of stakeholders. Our group has created a novel, multifaceted intervention that can potentially reduce the burden of readmissions on patients and the healthcare system. This intervention consists of an electronic health record (EHR)-integrated application designed to monitor cystectomy-specific convalescence and engage patients postoperatively through daily symptom monitoring, streamlined communication (bi-directional with both patient- and provider-facing components) when concerning symptoms arise, and targeted patient education. This approach allows for high-intensity monitoring throughout the post- operative period, facilitates early identification of complications by both patients and providers, removes barriers to timely communication allowing for more effective management, and does so with relatively low resource utilization by leveraging existing EHR and clinical infrastructure. The project proposes the following aims: 1) Determine the feasibility of using an EHR-integrated multifaceted intervention to monitor convalescence and trigger timely medical intervention in bladder cancer patients undergoing cystectomy; 2) Evaluate intervention acceptability; and 3) Identify facilitators and barriers to implementation across intended multi-institutional randomized trial sites. The preparatory work in this proposed R34 will result in creation of both the necessary infrastructure and stakeholder engagement to facilitate optimal implementation of our proposed future, multi-site randomized controlled trial intended to measure the efficacy of our intervention in reducing the burden of readmissions following cystectomy. If proven efficacious, our intervention is purposely designed to be easily scalable to other major cancer surgery and beyond.