Software could help prevent post-cystectomy readmission

Researchers have developed software that can be run on desktop computers, iPads, and iPhones to generate, in real time, whether a radical cystectomy patient is likely to be rehospitalized and when the urologist should follow up with the patient.

In a recent study about the decision support tool REACT: Readmission Elimination App for Cystectomy Treatment, authors write that the tool aims to quickly identify clinical deterioration. More customization and testing are needed, however, before urologists can begin using it.

REACT uses models that analyze published data to come up with optimal timing for office visits and phone calls, so that urologists are most likely to identify radical cystectomy patients at high readmission risk before those readmissions occur. The authors calibrated and validated REACT using radical cystectomy patient data from 2009 to 2010 Healthcare Cost and Utilization Project State Inpatient Databases, as well as the University of Michigan’s bladder cancer database from 2007 to 2011.

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This is an area ripe for innovation, according to study author Tudor Borza, MD, MS, of the University of Michigan, Ann Arbor.

“Novel approaches are paramount to decreasing readmissions following cystectomy. Despite multiple efforts by clinical leaders, readmission rates after cystectomy have remained stable at around 25% over the past decade,” Dr. Borza said. “This decision tool provides an additional dimension that can augment traditional care and reduce readmissions.”

REACT uses input from not only urologists, but also patients, according to Dr. Borza.

Next: “The intent of this tool is to facilitate follow-up of patients following radical cystectomy"

“The intent of this tool is to facilitate follow-up of patients following radical cystectomy and empower patients to be active participants in their care with the aim of reducing readmissions. The tool allows a patient to input clinical and demographic information and generates a prediction curve for when readmission is most likely,” Dr. Borza said. “This then allows the patient to remain engaged and vigilant in monitoring changes in their convalescence. The tool also provides easier access to appropriate personnel in the urology clinic to facilitate contact with providers, and allows patients to input medication lists and generates reminders to ensure adherence.”

Dr. Borza and his colleagues envision patients accessing the app at the time of discharge following cystectomy.

“We expect that the combination of all these factors will lead to better patient care, fewer readmissions following cystectomy, and a greater number of patients triaged by urology professionals, as opposed to emergency or primary care physicians,” Dr. Borza said.

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The authors are planning to pilot the tool at the University of Michigan and expect to have it available for urologists in 12 to 18 months. Once available, the tool will be free to use, according to Dr. Borza.

While this first application is for bladder cancer care, the tool could be adapted and used following any surgery, he said.

“However, that will require calibration and validation for each specific procedure,” Dr. Borza said. “As readmissions are relatively uncommon following most other urologic procedures, we envision this tool being more helpful following other major surgery with high rates of readmission, like colectomy, coronary artery bypass grafting, and abdominal aortic aneurysm repair.”

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