Primary Research
Our primary research focuses on identifying, understanding, and reducing disparities in surgery. Health disparities in surgery (i.e., surgical disparities) exist. Many surgical populations suffer from disproportionately worse access, care and outcomes in surgery. Racial/ethnic disparities, which represent one type of disparity, have been demonstrated across many surgical disciplines including colorectal surgery. With post-operative lengths-of-stay spanning 8-12 days, post-operative complication rates approaching 30 percent and 30-readmission rates of 15 percent, colorectal operations account for nearly 25 percent of all complications in general surgery. African American patients have even worse outcomes with higher mortality, longer length-of-stays and more readmissions. The factors that would reduce these inequities are unknown, which exposes a major gap in our understanding of surgical disparities and our ability to reduce them. Our team uses both quantitative (big data, clinical registries, etc.) and qualitative (focus groups, interviews, etc.) methods to help address these questions. We also apply important concepts, such as health literacy, to better frame our approaches. Ultimately, these research findings will be used to improve the care for all surgical patients.
Enhanced Recovery Programs
Enhanced Recovery Programs (ERP) (also known as Enhanced Recovery After Surgery (ERAS) pathways) link multimodal perioperative processes (e.g., patient education, early mobilization, non-opioid pain regimens etc.) into a fully integrated package to reduce length of stay, post-operative complications and readmissions for patients after colorectal surgery. ERPs are a model through which we may better understand mechanisms of disparities at the patient, provider and healthcare system levels. In addition ERPs align our clinical and research interests and provides a real-time platform to assess and improve surgical quality at the local, regional, and national level.
Health Literacy
Low health literacy is associated with poor health outcomes in many chronic diseases and may have as important role in determining surgical outcomes. Studies including our own, have observed that patient education, understanding, and engagement in surgical processes lead to better surgical outcomes and even reduced disparities. These observations suggest a potential role for health literacy, defined as an individual’s capacity to obtain, process and understand health information, in determining surgical outcomes. Under the Health Literacy and Outcomes Framework, these determinations are potentially modifiable with literacy-based interventions at the healthcare system and provider-level. While such interventions have been reported in many non-surgical fields, comprehensive literacy based interventions in surgery do not exist. Our lab is therefore focused on developing, and implementing, health-literacy based interventions in surgery.
Patient Engagement Technology
Patient engagement technologies (PETs) promote patient engagement, remote monitoring, and virtual care to better engage, educate, and track patients before, during, and after surgery. As part of UAB’s ERP initiative, a PET (SeamlessMD) was implemented to allow patients to stay connected and engaged before and after surgery. Increasing evidence for several institutions has shown that PETs can reduce hospital length of stay, readmissions, ER visits, SNF use and costs. Our lab has focused on further characterizing these benefits and on identifying those populations who may be let behind by PETs.
