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

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.

Grant Number: 1R34CA297281-01A1
NIH Institute/Center: NIH
Principal Investigator: Tudor Borza