title: A Model to Optimize Followup Care and Reduce Hospital Readmissions after Radical Cystectomy.
abstract: Radical cystectomy has one of the highest readmission rates across all surgical procedures at approximately 25%. We developed a mathematical model to optimize outpatient followup regimens for radical cystectomy.
  
  
  
  We used delay-time analysis, a systems engineering approach, to maximize the probability of detecting patients susceptible to readmission through office visits and telephone calls. Our data source includes patients readmitted after radical cystectomy from the Healthcare Cost and Utilization Project State Inpatient Databases in 2009 and 2010 as well as from our institutional bladder cancer database from 2007 to 2011. We measured the interval from hospital discharge to the point when a patient first exhibits concerning symptoms. Our primary end point is 30-day hospital readmission. Our model optimized the timing and sequence of followup care after radical cystectomy.
  
  
  
  The timing of office visits and telephone calls is more important in detecting a patient at risk for readmission than the sequence of these encounters. Patients are most likely to exhibit concerning symptoms between 4 and 5 days after discharge home. An optimally scheduled office visit can detect up to 16% of potential readmissions, which can be increased to 36% with 1 office visit followed by 4 telephone calls.
  
  
  
  Our model improves the detection of concerning symptoms after radical cystectomy by optimizing the timing and number of outpatient encounters. By understanding how to design better outpatient followup care for patients treated with radical cystectomy we can help reduce the readmission burden for this population.
authors.affiliation: University of Michigan Medical School, Ann Arbor, Michigan. Electronic address: nivvy@umich.edu.
authors.forename: Naveen
authors.initials: N
authors.lastname: Krishnan
authors.affiliation: Departments of Industrial & Operations Engineering, University of Michigan College of Engineering, Ann Arbor, Michigan.
authors.forename: Xiang
authors.initials: X
authors.lastname: Liu
authors.affiliation: Departments of Industrial & Operations Engineering, University of Michigan College of Engineering, Ann Arbor, Michigan.
authors.forename: Mariel S
authors.initials: MS
authors.lastname: Lavieri
authors.affiliation: Departments of Industrial & Operations Engineering, University of Michigan College of Engineering, Ann Arbor, Michigan.
authors.forename: Michael
authors.initials: M
authors.lastname: Hu
authors.affiliation: Department of Urology, Ann Arbor, Michigan.
authors.forename: Alexander
authors.initials: A
authors.lastname: Helfand
authors.affiliation: Department of Urology, Ann Arbor, Michigan.
authors.forename: Benjamin
authors.initials: B
authors.lastname: Li
authors.affiliation: Indiana University Kelley School of Business, Bloomington, Indiana.
authors.forename: Jonathan E
authors.initials: JE
authors.lastname: Helm
authors.affiliation: Department of Urology, Ann Arbor, Michigan; Dow Division of Health Services Research, Ann Arbor, Michigan.
authors.forename: Chang
authors.initials: C
authors.lastname: He
authors.affiliation: Department of Urology, Ann Arbor, Michigan; Dow Division of Health Services Research, Ann Arbor, Michigan; Division of Oncology, University of Michigan, Ann Arbor, Michigan.
authors.forename: Brent K
authors.initials: BK
authors.lastname: Hollenbeck
authors.affiliation: Department of Urology, Ann Arbor, Michigan; Dow Division of Health Services Research, Ann Arbor, Michigan; Division of Oncology, University of Michigan, Ann Arbor, Michigan; VA HSR&D Center for Clinical Management Research and VA Ann Arbor Healthcare System, Ann Arbor, Michigan.
authors.forename: Ted A
authors.initials: TA
authors.lastname: Skolarus
authors.affiliation: Department of Urology, University of Pittsburgh, Pittsburgh, Pennsylvania.
authors.forename: Bruce L
authors.initials: BL
authors.lastname: Jacobs
mesh_terms: D000359:Aftercare / Q000458:organization & administration*; D000368:Aged; D015653:Cystectomy / Q000009:adverse effects*; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D010351:Patient Discharge / Q000639:trends; D010359:Patient Readmission / Q000639:trends*; D011183:Postoperative Complications / Q000453:epidemiology*; D012189:Retrospective Studies; D015996:Survival Rate / Q000639:trends; D013997:Time Factors; D014481:United States / Q000453:epidemiology; D001749:Urinary Bladder Neoplasms / Q000601:surgery*
keywords: ambulatory care; cystectomy; patient readmission; postoperative care