Using a Mobile Application for Real-Time Collection of Patient-Reported Outcomes in Hepatopancreatobiliary Surgery within an ERAS® Pathway

Am Surg. 2019 Aug 1;85(8):909-917.

Abstract

Patient-reported outcomes (PROs) are essential for patient-centered health care. This pilot study implemented a mobile application customized to an hepatopancreatobiliary Enhanced Recovery After Surgery (ERAS®) program-a novel environment-for real-time collection of PROs, including ERAS® pathway compliance. Patients undergoing hepatectomy, distal pancreatectomy, or pancreaticoduodenectomy through the ERAS® program were prospectively enrolled over 10 months. The application provided education and questionnaires before surgery through 30 days postdischarge. Thresholds were set for initial adoption of the application (75%), PRO response rate (50%), and patient satisfaction (75%). Daily postdischarge health checks integrated customized responses to guide out-of-hospital care. Of 165 enrolled patients, 122 met inclusion criteria. Application adoption was 93 per cent (114/122) and in-hospital engagement remained high at 88 per cent (107/122). Patients completed 62 per cent of PRO on quality of life, postoperative pain, nausea, opioid consumption, and compliance to ERAS® pathway items, including ambulation and breathing exercises. During postcharge tracking, 12 patients reported that the application prevented a phone call to the hospital and three patients reported prevention of an emergency room visit. PRO collection through this mobile device created an integrated platform for comprehensive perioperative care, patient-initiated outcome tracking with automatic reporting, and real-time feedback for process change. Improving proactive outpatient management of complex patients through mobile technology could help restructure health-care delivery and improve resource utilization for all patients.

MeSH terms

  • Analgesics, Opioid
  • Computer Systems
  • Convalescence
  • Elective Surgical Procedures
  • Hepatectomy*
  • Humans
  • Mobile Applications / statistics & numerical data*
  • Pancreatectomy*
  • Pancreaticoduodenectomy*
  • Patient Compliance / statistics & numerical data
  • Patient Reported Outcome Measures*
  • Patient Satisfaction / statistics & numerical data*
  • Perioperative Care
  • Pilot Projects
  • Postoperative Care / methods*
  • Postoperative Care / statistics & numerical data
  • Postoperative Nausea and Vomiting
  • Postoperative Pain
  • Program Evaluation
  • Prospective Studies
  • Quality of Life

Substances

  • Analgesics, Opioid