University of Wisconsin–Madison

Reducing Readmission After Complex Cancer Surgery

  • Overview: Following an initial hospitalization for complex cancer surgery, the rate of return to the hospital (readmission) is very high, occurring in one of every five patients. In addition, the cost of all unplanned readmissions in Medicare patients is exorbitant, at over $17 billion. This research evaluates the causes of poor outcomes, such as readmission, in a health care system using the Systems Engineering Initiative for Patient Safety (SEIPS) model. The SEIPS model provides a detailed look at the complex interplay of factors (i.e., patient/caregiver, technology and tools, tasks, organization, and environment) that influences the risk of readmission, rather than placing blame on any one particular person or part of the system. Although large dataset analyses have delineated some of the clinical risk factors for readmission, there is a paucity of data evaluating the risk factors from the patient’s perspective. In addition, no study has evaluated the etiology for readmission using a human factors and systems engineering approach. Because of this gap, it is likely that there are missed opportunities to improve the quality of care for cancer patients by decreasing the readmission rate after surgery. This is particularly important since these operations are planned, resulting in a window of opportunity before surgery where an intervention could occur to decrease the risk of readmission.

    Aims: The goals of the project include assessing the cause of readmission from the patient and caregiver’s perspective and assessing the clinical risk factors associated with increased risk of readmission.

    Method: This project seeks to apply a systems engineering approach to evaluate the cause of readmission in patients who have undergone complex cancer surgery and were readmitted within 30 days, evaluating the perspective of the patient and his/her caregivers as the central figures in the analysis.  These patient derived risk factors will be incorporated into a known readmission reduction tool, the C-TraC protocol, developed at University of Wisconsin. After obtaining the data included in this proposal, this surgery-specific, patient-centered readmission reduction tool will be tested in a follow-up study to evaluate whether it will decrease the readmission rates for these complex patients.

    Funding: ICTR Pilot Projects program

  • Sharon M. Weber, MD
    Section of Surgical Oncology, Division of General Surgery
    Vice Chair, Division of General Surgery, Academic Affairs
    School of Medicine and Public Health
    University of Wisconsin-Madison

    Pascale Carayon, PhD
    Procter & Gamble Bascom Professor in Total Quality
    Department of Industrial and Systems Engineering
    Director, Center for Quality and Productivity Improvement
    University of Wisconsin-Madison

    Caprice C. Greenberg, MD, MPH
    Associate Professor, Surgery
    School of Medicine and Public Health
    Director, Wisconsin Surgical Outcomes Research Program
    University of Wisconsin-Madison

    Amy Kind, MD, PhD
    Assistant Professor, Geriatrics
    School of Medicine and Public Health
    Director, Madison VA Coordinated Translational Care
    University of Wisconsin-Madison

    Tamara LeCaire, PhD
    Wisconsin Surgical Outcomes Research Program
    Department of Surgery, Divisions of Otolaryngology and General Surgery
    School of Medicine and Public Health
    University of Wisconsin, Madison

    Emily R. Winslow, MD, FACS
    Assistant Professor
    Section of Surgical Oncology, Division of General Surgery
    University of Wisconsin-Madison

  • Acher, A. W., LeCaire, T. J., Hundt, A. S., Greenberg, C. C., Carayon, P., Kind, A. J., & Weber, S. M. (2015). Using human factors and systems engineering to evaluate readmission after complex surgery. J Am Coll Surg, 221(4), 810-820. doi:10.1016/j.jamcollsurg.2015.06.014  PMC4782927

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