Our current healthcare system measures providers based on a set of standardized outcomes that may not reflect what patients truly want from their health care, especially for patients with complex medical needs such as older and seriously ill patients. As a result, patient and provider priorities may not always align, leading to discordant care. The Geriatrics and Serious Illness in Surgery Program at CSPH believes that the priorities of the patient matter, and that not only should these priorities be incorporated into the standards by which providers are measured, but also that patients should play a central role in the decision-making process regarding their care. This approach allows patients to assess the outcomes and goals they hold for themselves, and surgeons to provide care that aligns with their patient’s priorities.
The Geriatrics and Serious Illness in Surgery Program conducts patient-centered research focused on surgical patients with serious illnesses facing complex surgical procedures. The program’s vision is to create an internationally renowned group of clinician-scientists and health services researchers who conduct patient-centered research in all phases of surgical care. The program aims to accomplish this through unparalleled leadership in the following ways: making significant contributions to the scientific evidence base, developing and implementing novel programs, and by engaging key stakeholders in surgical care to influence health policy.
With a team that includes more than a dozen researchers and collaborators, the Geriatrics and Serious Illness in Surgery Program’s project portfolio continues to expand, covering a wide range of research topics and implementation strategies dedicated to making surgical care more patient-centered and developing protections for vulnerable groups. Projects include: a pilot study on collecting patient-reported outcome measures for older Emergency General Surgery (EGS) patients; secondary data analysis to describe the 12-month healthcare trajectory and hospice utilization among older trauma and EGS patients; identifying best practice guidelines for older injured adults; developing Quality of Life and functional measures for older patients and incorporating them into the National Surgical Quality Improvement Program (NSQIP); and ensuring that shared decision making is routinely incorporated into the Perioperative Medicine Curriculum during anesthesia residents’ Weiner Center rotation at BWH.
Alex Arriaga, MD, MPH, ScD
Deborah Culley, MD
David Hepner, MD, MPH
Charlotta Lindvall, MD
Richard Urman, MD, MBA
Nicholas Sadovnikoff, MD
Daniel Weiner, MD
Joel Weissman, PhD
Senior Project Manager – Masami Kelly, MA
Research Assistant – Kathleen Coogan
Research Assistant – Christina Sheu
Claire Sokas, MD
Developing Surgical Palliative Care Indicators
Providing palliative care to seriously ill patients is a national healthcare priority and is a critical aspect of providing the highest value to care to growing numbers of surgical patients who are ill or near the end of life. Establishing national standards surgical palliative care and quality indicators for benchmarking is necessary to fully integrate palliative processes of care into surgical care delivery.
The SHARPP team is using the RAND/UCLA appropriateness methodology to create a suite of standards and quality indicators to measure the quality of palliative care across the surgical episode. This includes:
- Convening an expert advisory panel to rate the quality and validity of candidate indicators
- Developing and refining a preliminary list of quality indicators to measure quality of palliative care delivery to surgery patients
Funding through Cambia Health Foundation and National Palliative Care Research Center
Using the Weiner Center for Preoperative Evaluation to develop an algorithm that can predict healthcare utilization or discharge disposition.
Natural Language Process
Using NLP with Charlotta Lindvall lab to understand code status and goals of care discussion documentation in medical charts.
Beyond 30 Days
Enrolling patients to understand their supportive care needs for those who undergo emergency general surgery.
Working with a Patient and Family Advisory Council (PFAC)
In 2015, the SHARPP team began their study “Navigating High Risk Surgery: Empowering Older Patients to Ask Questions that Inform Decisions about Surgical Treatment” to help us understand communication between patients and surgeons. The Patient and Family Advisory Council (PFAC) played a critical role in addressing some of the barriers they faced while recruiting patients and disseminating results. A Patient and Family Advisory Council (PFAC) is a group of patients, family members, and staff at an institution that provides patient support services, health system feedback, and act as advocates to improve the patient experience and ensure patient and family-centered care.
PFACs help to inform institutions on what matters to patients, encourage the alignment of research and patients’ goals, and facilitate the distribution and dissemination of research findings in a way that is accessible and understandable to patients and family members. In recent years, researchers and funders have recognized the value and importance of integrating the patient and family perspective into the design, conduct, and dissemination of research studies. Its success has led to a growing national interest in ethically and effectively integrating patients into patient-centered research.
- Cancer and Comparative Effectiveness3
- CSPH Fellowship2
- Emergency General Surgery1
- Geriatrics and Serious Illness6
- Global Surgery5
- Health Policy8
- Long-Term Outcomes3
- Military Health Outcomes5
- Stop the Bleed3
- Surgical Culture5
- Surgical Disparities3