E377: Pilot Implementation Evaluation of a Remote Education, Communication and Monitoring Ecosystem (E-CARE) After Hepatobiliary Surgery

Nearly half of complications after abdominal cancer surgery occur post-discharge. Thus, patients and caregivers must assume responsibility for post-discharge recovery, including self-management and early complication recognition. To better support patients during this vulnerable period, we developed a remote education, communication and monitoring ecosystem (E-CARE). Our objectives were to (1) evaluate the pilot implementation of E-CARE among patients undergoing hepatobiliary surgery, and (2) assess the impact of E-CARE on post-discharge acute care visits.

Methods:

Patients who underwent hepatobiliary surgery were invited to participate in E-CARE, a platform that begins in the preoperative setting and extends 30-days post-discharge (2019-2023). We compared patients who engaged with the program to a control group who underwent hepatobiliary surgery and did not use E-CARE. Pilot implementation outcomes included adoption (defined as initial activation of E-CARE) and fidelity (defined by engagement with E-CARE). Pilot implementation effectiveness included unplanned outpatient and emergency department (ED) visits.

Results:

Of 335 patients, 276 (82.4%) were not offered E-CARE and 59 (17.6%) were invited to participate. Of those invited, 55 (93.2%) activated and 49 (83.1%) engaged with E-CARE. Compared to controls, patients who engaged with E-CARE were on average younger (54.4 vs. 62.4 years), more frequently privately insured (75.5% vs. 46.5%), and more frequently African-American (14.3% vs. 8.4%) (all p< 0.05). No significant differences in comorbidities were seen. Among patients who engaged with E-CARE, alerts were generated in 33 (67.3%) patients, including 11 of 12 (91.7%) who had a complication and 22 of 37 (59.5%) who did not have a complication. The most common post-discharge complications were surgical site infections, acute respiratory/cardiac complications, and ileus. Patients who engaged with E-CARE had significantly fewer ED treat-and-release visits (0.0% vs, 8.0%, p=0.03), but no significant differences in inpatient admissions or outpatient visits (Table).

Conclusions:

E-CARE had high adoption and fidelity and was associated with decreased ED treat-and-release visits without significantly increasing outpatient visits. These results highlight the feasibility and benefits of a remote monitoring system for patients undergoing complex, highly comorbid hepatobiliary surgeries. Future work is needed to further understand scalable implementation processes and outcomes.