Exploring the utilization of post-discharge care in colorectal surgery patients

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Project Summary Readmissions and emergency department (ED) visits after surgery are costly and burdensome. Colorectal surgery (CRS) patients in particular have unique concerns after surgery, such as new ostomies, wound care issues, and altered bowel habits. These concerns increase their likelihood of postoperative complications and need for unplanned and high resource health care utilization (UHRHU), such as readmissions and ED visits, after CRS. To date, most existing research and successful interventions for readmission have been targeted towards non-surgical patients. Very little prospective data exist examining the spectrum of postoperative care, which includes both optimal healthcare utilization, such as telephone encounters and clinic visits, as well as suboptimal healthcare utilization, such as unplanned readmissions and ED visits. We propose to examine the readmission and ED utilization patterns of CRS patients within thirty days of discharge from our large, tertiary, academic, North Carolina Hospital. We will combine electronic medical record review with targeted patient interviews to obtain novel information about exactly how, why, and where patients receive their postoperative care. These data collectively will explain any particular risks factors and motives that may influence UHRHU after CRS. We will accomplish this through the following aims: Aim 1: To determine whether or not early follow up with the primary surgeon's clinic decreases UHRHU (i.e. readmission or ED use). Aim 2: To identify the patient experience of postdischarge care utilization and perception of care coordination after CRS. Aim 3: To compare and integrate the “what” and “why” of how CRS patients obtain their postdischarge care. We hope to develop from this information an effective transitional care intervention specific to CRS patients that will be effective for reducing the unnecessary cost, worse patient outcomes, and undue burden associated with UHRHU.