Developing an Interactive, Patient-Centered mHealth Tool to Enhance Post-Cystectomy Care (North Carolina)

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Summary:

Quality of surgical care has traditionally been evaluated based on inpatient outcomes, including complications and mortality. More recently, quality assessment and reimbursement are being based on postdischarge outcomes. Because of this, hospitals are working to identify actionable quality improvement strategies to reduce 30-day, risk-adjusted surgical outcomes, such as readmissions. Among surgical patients, readmissions are most common among elderly patients undergoing major abdominal surgery for cancer, such as cystectomy for bladder cancer. Complications leading to readmissions may be mitigated, if they are rapidly identified and addressed. Patient-centered outcomes (PCOs), including symptoms, functional status, and medication adherence, represent potential treatment targets following hospital discharge. Strategies incorporating PCOs and improved postdischarge care for radical cystectomy and other surgical oncology procedures have the potential to reduce postsurgical readmissions, with the potential for dramatic public health impact.

Using radical cystectomy as a model, this project will develop and pilot test an electronic, Internet-based, mobile health (mHealth) tool that will prospectively collect PCO data on key symptoms, functional status, and medication adherence, while providing timely feedback to patients and clinicians.

The specific aims of this project are as follows:

  • Identify high-priority PCOs in the postoperative cystectomy period through patient, caregiver, and provider in-person interviews
  • Develop and test the usability of an Internet-based mHealth tool that tracks PCOs and provides real-time feedback to patients and providers following cystectomy discharge
  • Conduct a pilot study to assess feasibility and acceptability of an Internet-based mHealth tool following cystectomy discharge

This proposed mHealth intervention will use an existing electronic platform called PROCore that can be accessed through multiple technologies, including laptops, mobile phones, tablets, and other computer-based systems. Monitoring postsurgical patients using this mHealth intervention may have a significant impact on postoperative outcomes following discharge by reducing readmissions and emergency room visits, increasing patient satisfaction, and decreasing mortality.

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