The Cascade Feasibility Pilot (Ileostomy)

Not Applicable

Completed

Interventions: Other: Non-invasive continuous remote monitoring with structured escalation pathway
Other: Affective Analysis of Participant Response to Continuous Remote Patient Monitoring

Brief Summary: Existing interventions including improving communication and self-care to improve readmission of patients undergoing high risk colorectal surgery involving new ileostomy formation has shown limited results. Our proposal is to deploy a wearable solution that predicts physiological perturbation with continuous remote patient monitoring and advanced machine learning algorithms which will be connected to structured, cascading, escalation pathways and care coordination involving home health nurses, colorectal and ostomy nurses, and colorectal surgeons, and has the potential to transform surgical management in the post-discharge period, where patients are the most vulnerable for readmission. This feasibility study will contribute to the understanding of post-discharge continuous remote monitoring of ileostomy patients, promote patient self-care, and has the potential of improving patient outcomes.

Detailed Description: Colorectal surgery is a high-risk surgery that results in significant morbidity, and health care utilization in the form of readmission. Ileostomy creation is a significant risk factor in colorectal surgery rehospitalization. Effective continuous remote patient monitoring (CRPM) can reduce readmissions, but it has only been realized in select heart failure populations via invasive monitoring. The investigators will focus on colorectal CRPM in the elective, new ileostomy population through a structured cascading and escalating alert system. In this feasibility study, the investigators will use a wearable biosensor and collect ambulatory physiological data that are analyzed by machine learning algorithms, to generate personalized alerts of physiological perturbation in colorectal surgery patients in the post-discharge period. Alerts from this algorithm may be cascaded with other patient status data to inform management by the home health team via a structured protocol built into the electronic health record (EHR). The escalation pathway will engage home health nurses, colorectal care team nurses, ostomy nurses, and colorectal surgeons. The investigators will conduct surveys and semi-structured interviews with patients, and semi-structured interviews with providers, which will be used to evaluate the perceptions, acceptance, and experience of this CRPM solution.

Recruitment & Eligibility

Inclusion Criteria

Exclusion Criteria

Patient has cognitive or physical limitations that, in the investigator's opinion, limit the patient's ability to maintain patch device and phone
Patient has allergy to hydrocolloid adhesives
Patient has present skin damage preventing them from wearing a study device
Pregnancy
Patient discharge location is a Skilled Nursing Facility or other subacute facilities

Arm && Interventions

Group	Intervention	Description
Ileostomy Cohort	Non-invasive continuous remote monitoring with structured escalation pathway	The study will include ten eligible patients into the cohort to conduct the study.
Ileostomy Cohort	Affective Analysis of Participant Response to Continuous Remote Patient Monitoring	The study will include ten eligible patients into the cohort to conduct the study.

Primary Outcome Measures

Name	Time	Method
Enrollment Rate	Through study completion, an average of 30 days for each patient	Enrollment rate for entire patient cohort
Attrition Rate	30 days from patient discharge date	Drop out from study

Secondary Outcome Measures

Name	Time	Method
Number of Participants With Stool Regimen Escalation	30 days from patient discharge date	Frequency of stool regimen escalation by providers
30 Days Readmission	30 days from patient discharge date	30-day readmission to hospital

Locations (3): NorthShore University HealthSystem HighlandPark Hospital
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Highland Park, Illinois, United States
NorthShore University HealthSystem Glenbrook Hospital
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Glenview, Illinois, United States
NorthShore University HealthSystem Evanston Hospital
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Evanston, Illinois, United States