Project Summary/Abstract Severe complications after thoracic surgery are common and lead to increased readmissions and mortality. The early symptoms of developing complications may not be detected by the usual scheduled postoperative care before they worsen and become severe. Postoperative care can be done remotely and in real-time with automated systems that electronically deliver surveys to patients to directly capture patient- reported outcomes and send alerts to providers for concerning responses (ePROs). ePROs improve quality of life, healthcare utilization, and survival in several large clinical trials as well as have emerging evidence of clinical effectiveness in real-world applications in oncology patients. ePROs also have been shown to be feasible for symptom management in small trials of thoracic and colorectal surgery patients. These data suggest ePROs have the potential to improve care after thoracic and other high-risk surgery. However, there are no widely implemented ePRO systems in routine surgical care, despite evidence from other settings to support the value of systematically identifying and then addressing anticipated barriers to implementation in the ePRO design. Current gaps in knowledge to designing ePROs for use in surgical care include identifying optimal survey/alert features and workflow, barriers to routine use, and clinical effectiveness. The candidate for this career development award, Dr. Mody, is a thoracic surgeon whose career goal is to improve clinical and patient-centered outcomes for patients with chronic lung conditions requiring surgery. The proposed award will build on her prior MPH that included formal training in biostatistics and health services research and will provide advanced training in areas necessary for her to achieve her career goals. Specifically, during the award period Dr. Mody will receive training in qualitative data analysis including mixed methods and implementation science research methods. Dr. Mody will perform a prospective study of implementation and effectiveness outcomes in thoracic surgery clinics using postoperative ePROs. To ensure her success, an interdisciplinary team of mentors and advisors with complementary expertise have been enlisted including Dr. Ethan Basch (clinical trials in oncology, PRO research), Dr. Jennifer Leeman (implementation, qualitative research), Dr. Antonia Bennett (quality of life measurement, qualitative research), Dr. Andrea Pusic (clinical trials in surgery, PRO research), Dr. Angela Smith (surgery, health information technology for PRO measurement), and Dr. Angela Stover (implementation of PROs). By the end of the award period, Dr. Mody will have the necessary preliminary data and training to successfully perform a large scale randomized controlled trial to evaluate the implementation and effectiveness of an ePRO system in cardiothoracic surgery patients. Designing and evaluating such a system in thoracic surgery patients first is important as they serve as a model for the increasing numbers of medically complex patients requiring invasive treatments for chronic conditions and for whom ePROs may substantially improve outcomes.

Project Narrative Recovery from thoracic surgery (used to treat common chronic lung conditions) is associated with serious complications which may be prevented if more effective early detection and management strategies existed. Based on evidence from improved outcomes in oncology, electronic systems for monitoring patient-reported outcomes (ePROs), which are symptoms reported directly from the patient, are one potential solution. This application proposes to bridge the gap in knowledge on the optimal ePRO system design, how to use ePROs in surgery, and the benefits of ePROs in surgery using rigorous implementation science approaches.