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New Funding: Opportunities for Improving Care

(2 comments)

CERTAIN is comprised of a suite of programs and projects that track quality, benchmark best practices, drive improvement, and allow all healthcare stakeholders to have their input heard as to what is needed to improve the healthcare system. Funding for our work comes from a variety of organizations interested in solving the most pressing problems in healthcare, and we are grateful for their support. We are excited to begin work on three recently-funded projects:

Practice Patterns and Impact in Treating Diverticulitis
Diverticulitis is a painful condition where small pouches of the colon (diverticula) become inflamed and infected.  It is one of the leading causes for colon resection—the surgical removal of part or all of the large intestine. In recent years, CERTAIN has been actively researching current trends and assessing the appropriateness of surgical care for treating diverticulitis. 

In July 2015, CERTAIN was awarded a 5-year grant from the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) for a study titled “Practice Patterns and Impact of Operative and Non-operative Management of Diverticulitis.” Although professional guidelines recommend delaying elective surgery for treating diverticulitis, the number of these surgeries being performed is actually increasing.  This new study is designed to determine whether or not the dramatic increase in the use of elective surgery for diverticulitis is consistent with recommendations about delaying intervention.

Understanding the factors associated with decisions about elective surgery, and assessing the impact of diverticulitis on patients, is necessary to help produce treatment options aimed at more patient-centered and value-added care. This funding from NIDDK will be used to:

    1. Compare the number of occurrences of diverticulitis prior to surgery between those undergoing laparoscopic vs. open resection,
    2. Compare how often patients undergoing early vs. delayed resection report clinical and non-clinical factors as the reason for elective resection, and
    3. Compare changes over time in the patient-reported burden of diverticulitis among those who do and do not undergo surgery.

Understanding Non-response in Spine Fusion Surgery
Spine surgeries represent the most expensive routine inpatient hospitalizations in the United States. At the same time, there is immense variability in patient outcomes following elective spine surgery. Some patients see improvement in pain and/or function, whereas others experience no improvement at all (non-response), and the reasons for this variability are unclear.

CERTAIN has been awarded a 2-year grant from the National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS) for a study titled ”Understanding Non-response in Spine Fusion Surgery.” This study is designed to collect pilot data to identify patient characteristics associated with non-response after spine fusion surgery for the treatment of degenerative disc disease (DDD). These patient characteristics need to be determined in order to develop accurate predictive algorithms and ultimately help physicians understand risk factors for non-response and identify high-risk patients. This funding from NIAMS will be used to:

    1. Determine patient characteristics associated with non-response among patients undergoing lumbar fusion for DDD, and
    2. Determine radiographic features at baseline that are associated with non-response among patients undergoing lumbar fusion for DDD.

mPOWER
Surgical site infection (SSI) is a costly and common healthcare-associated infection, affecting 500,000 post-surgical patients in the United States annually. Developed by CERTAIN investigator Dr. Heather Evans, the Mobile Post-Operative Wound Evaluator (mPOWEr) is the first and only mobile health (mHealth) application to address the SSI risk patients face after they are discharged from the hospital and before their follow-up appointment. Using the patient’s own mobile device, the application can improve patient-provider communication and lead to earlier detection and treatment of Surgical Site Infections (SSI), reduced healthcare utilization, as well as increased patient satisfaction. In May, mPOWEr was awarded a $50,000 grant from the UW Patient Safety Innovation Program (PSIP). During this 18-month award, mPOWEr will accomplish the following aims:

    1. Describe the current workflow and barriers to quality post-discharge surgical wound care;
    2. Design an implementation plan for mPOWEr within the established workflow requirements, and 
    3. Pilot a full implementation of the mobile app platform 

This initiative will lay essential groundwork to study mPOWEr more broadly across a population of surgical patients as a novel tool to improve the quality of post-discharge care.

 

Contact us to learn more about any of these projects.


2 comments so far:

Do some surgeons know through experience or intuition which patients will be in the "non-response" group after spine fusion? My surgeon told me over the phone that he knows 10-20% of those he operates on for scoliosis will be dissatisfied somehow, and I would be one. For that reason he declined to operate on me and instead, referred me to a neuropsychologist. I met him once in an appointment and once at a workshop. What did he see?

Hi Judy,

That's essentially why we are doing this study - to give surgeons evidence and tools so they can better predict what patients will benefit from surgery, and those who are likely not to. There is some existing evidence, but we're hoping to build it out further.

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  • CERTAIN Medical Director Dr. David Flum on The Conversation with Ross Reynolds 4/11/12: listen here.