Developing an Interactive Patient-Centered mHealth Tool to Enhance Post-Cystectomy Care

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 post-discharge 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. Using radical cystectomy as a model, this research developed and tested a mobile health (mHealth) tool that collects this PCO data, while providing timely feedback to patients and clinicians.

The specific aims of the project were to:

• 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 discharge for cystectomy. 
• Conduct a pilot study to assess feasibility and acceptability of an Internet-based mHealth tool following discharge for cystectomy. 

As of March 2019, investigators have identified important PCOs and incorporated them into the mHealth tool. Twelve patients tested and provided feedback on the tool. Investigators iteratively incorporated suggestions until no further suggestions were made. Satisfaction surveys and semi-structured interviews were completed that demonstrated overwhelming support and satisfaction with the mHealth intervention.

This work will provide the preliminary data for a multisite randomized study to rigorously test the effectiveness of the mHealth tool. Investigators hope that the tool will prove to be significant as a practical way to improve the quality of care for cancer patients undergoing major surgery and reduce the high rate of post-discharge complications and readmissions.