Integrating Electronic Patient-Reported Outcomes into Discharge Planning - PROJECT SUMMARY A prolonged hospital stay after cancer surgery is a common but potentially avoidable problem that negatively impacts quality of care. Goal-directed pathways for discharge are widely used in surgical oncology to avoid unnecessary extended lengths of stay, but discharge milestones are maintained by the clinical team without patient input. The resultant discharge pathways are rigid, with little or no personalization, and the necessary steps in the process are often unclear to patients. These gaps in communication and mismatch in expectations between clinical care team members, patients, and caregivers contribute to excessive lengths of stay. Integration of patient-reported outcomes (PROs) into clinical care is one strategy shown to improve communication and align expectations. There may be great opportunity to use transition-of-care–focused PROs items in the hospital setting to align patient and clinical team members during discharge planning to prevent prolonged hospital stays. Hypothesis: A discharge-focused electronic PROs tool for surgical oncology patients will decrease the length of stay after elective surgery. PROs including readiness for discharge and activation will also be measured. Jennifer Cracchiolo, MD, has developed an electronic PROs tool, “Goals to Discharge” (G2D), for oncology patients focused on discharge planning to augment currently established discharge pathways. While the G2D tool has been successfully employed during hospitalization and patients have responded, there have been challenges to implementing this technology, including helping patients navigate the digital tool; devising strategies to increase response rates and ensure inclusivity; optimizing the content; and developing PROs-prompted clinical decision support for clinicians. In the proposed project, Dr. Cracchiolo will refine the library of actionable PROs items that measure domains relevant to inpatients and their readiness for hospital discharge. She will include patients from surgical oncology (colorectal, thoracic, and gynecologic surgery) at Memorial Sloan Kettering Cancer Center, with the goal of actively engaging patients during the discharge process. Aim 1: Refine content for the G2D tool with PROs-based clinical decision support. Aim 2: Systematically plan for broad clinical adoption of G2D using an implementation mapping approach. Aim 3: Pilot test the effectiveness of the G2D tool compared with usual care. Results will lead to better quality of care, better informed patients, and better outcomes. This research, along with the career development plan for training in advanced qualitative methods, implementation science, and clinical trial study design by her multidisciplinary mentors, Deborah Schrag, MD, MPH; Jamie Ostroff, PhD; Andrew Vickers, PhD; and Thomas Atkinson, PhD, will provide Dr. Cracchiolo with the infrastructure needed to grow in her career and facilitate her progress toward independence as a researcher in clinical integration of PROs systems in surgical oncology care.
