Emergency General Surgery Treatment of Older Multimorbid Patients

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PROPOSAL SUMMARY/ABSTRACT Each year in the United States, there are three million emergency general surgery hospital admissions, with 30% of these patients requiring surgical intervention. Multimorbid, older patients are a complex population encompassing immense health resource utilization, but outcomes data regarding the impact of multimorbidity on older emergency general surgery patients are lacking. This limits surgeon ability to set realistic expectations for patients, which is key to enacting goal-concordant care. Patient-centered care is a national standard under the Patient Protection and Affordable Care Act and has been shown to improve health outcomes and patient satisfaction. The “Best case/Worst case” communication tool is a validated instrument to facilitate treatment choice by using scenario planning to improve patient understanding of realistic outcomes. The impact of data on the use of this tool, however, has not yet been characterized. This project will (1) define the impact of multimorbidity on outcomes for older patients requiring emergency general surgery operations using comprehensive nationwide data analysis, (2) characterize the barriers and facilitators of integrating novel data into the Best case/Worst case communication tool through focus groups and complex qualitative analysis, and (3) create an education tool kit to integrate data into using the Best case/Worst case tool using implementation science. Beyond supporting the above research, the training goal of this project is to further Dr. Claire Rosen’s training in mixed methods biomedical ethics research with a focus on patient communication, and to prepare her to become an independent investigator. The above grant will support the education of Dr. Rosen, who will pursue a Master of Science in Medical Ethics through the University of Pennsylvania Department of Medical Ethics and Health Policy. This degree program has a primary goal of training physician-scientists aspiring to empirically oriented bioethics faculty positions in academic medical centers through structured content and scientific methods coursework and mentored research. This project fills a knowledge gap regarding the outcomes of multimorbid older emergency general surgery patients and uses qualitative analysis and implementation science to improve patient-centered care and communication, striving towards national demands for higher quality care. The work will be a major step in enabling Dr. Rosen to become an independent investigator, expert in biomedical ethics, and advocate for older, multimorbid emergency general surgery patients.