Every year about 3 million children in the United States experience significant anxiety prior to surgery and pain following surgery. Not only are these high levels of pain and anxiety emotionally traumatic to the child and family, but also recent data indicate that high levels of anxiety and pain will lead to impaired psychological and clinical recovery following the surgery. Over the past 2 decades, a number of hospital-based interventions have been shown to be effective in the treatment of perioperative anxiety and pain. Unfortunately, use of these interventions has decreased significantly over the past decade, most likely due to both the dramatic shift toward low-cost outpatient surgery and other cost-containment efforts. The recent healthcare reform and poor financial performance by hospitals over the past few years have further accelerated this process. The growing emphasis on health technology provides an opportunity to transform preparation and management of surgery with the use of mobile-based, tailored interventions. Previously, the NICHD awarded the PI of this application a 2-year grant to focus on the development of a web- based tailored intervention (WebTIPS) directed at children age 2-7 years who are undergoing outpatient surgery and their family as well as the involved healthcare providers. To date, the PI has developed the intervention and has demonstrated through a formative evaluation process high usability and likeability of the intervention. The PI also conducted a feasibility RCT and demonstrated, using a usual care control group, that WebTIPS is effective in reduction of preoperative anxiety and postoperative emergence delirium. The purpose of this R01 application is to examine the efficacy of WebTIPS in a large scale clinical trial using an attention control RCT design and validated 30-days outcome measures that are framed within the recently introduced conceptual framework of the ?Triple Aim?. This framework calls for new interventions to be evaluated within the context of: better clinical outcomes, better patient satisfaction and lower resource utilization. We submit that WebTIPS has the potential to transform current perioperative care of millions of children and their families with an enhanced perioperative journey.
At the conclusion of this application, using the ?Triple Aim? concept, we will have tested a mobile-based tailored intervention that is aimed at improving the surgical experience of families and children undergoing outpatient surgery. This is of high public health significance as many millions of children undergo surgery in the US and many of these children experience significant perioperative anxiety and pain which can lead to delayed psychological and clinical postoperative recovery and poor patient and family experience. We strongly believe that this innovative mobile-based intervention will transform the perioperative approach of children and their families and improve the clinical course (e.g. reduced pain and anxiety), family experience (better satisfaction scores) and lower cost (e.g. lower cancelation of cases and other). Once tested, we plan to disseminate this mobile-based intervention to all surgical facilities providing services to children in the US.