For the past five years, the Michigan Surgical and Health Optimization Program at Michigan Medicine has been working with patients undergoing large operations, such as cancer surgeries or transplants, to help them better prepare for their procedures during the waiting period. MSHOP has led to reduced costs of care and improvements in recovery.

Dr. Michael Englesbe, a transplant surgeon running MSHOP, said there could be up to a two-month gap between when a patient schedules a surgery and when they undergo the procedure.

“It can be a really scary time for patients, they’re just waiting for the big operation,” Englesbe said. “So during that time, instead of waiting and worrying we’ve started training patients.”

Englesbe uses the analogy of a 5K race, pointing out most people train for a race. Translating that into surgery, patients work toward meeting health and wellness goals in time for their surgery to optimize their recovery. These goals include focusing on nutrition, walking, exercising, stopping smoking and other wellness activities.

The feedback for the program has been overall positive, Englesbe said. The patient compliance for the study is 80 percent, which is much higher than most other lifestyle-intervention and wellness studies or programs.

“Patients appreciate the opportunity to be empowered and actively engaged in their care,” Englesbe said. “It helps them reduce stress and gives them something to focus on.”

Dr. Stewart Wang, a professor of surgery at the Medical School, helped create some of the technology for the program. In an email interview, Wang wrote the program has been made to be more customizable for the patient.

“We have markedly improved our technology based monitoring of patient progress so that we can intervene (or just provide encouragement) as needed to optimize progress,” Wang wrote. “We make patient progress over the course of the program easier for the patient themselves to monitor and also allow them to recruit friends and family to help them achieve their goals.”

Wang wrote he has been working with patient-betterment technologies and software algorithms in conjunction with the U-M Department of Surgery to make MSHOP a more streamlined program.

“My group is also adapting the original MSHOP technology I developed so that it can work in settings other than an academic medical center, which is where the vast majority of clinical care in the US takes place,” Wang wrote. “We are translating the program out into the real-world healthcare marketplace.”

According to a previous Michigan Medicine newsletter, “Program facilitators worked to craft notes with positive, natural-sounding language to make the exchanges personal and more effective.”

Currently, MSHOP is primarily available at Michigan Medicine and certain practices across the state of Michigan. Applying the program on a larger scale is a slow process, Englesbe said.

“The program takes time for nurses and doctors, and most nurses and doctors are already working full time,” Englesbe said. “Any additional kind of work is difficult to implement; you need to pay them.”

Englesbe said they’ve begun working with Blue Cross and Blue Shield to discuss a way to compensate those spending time training patients.

A MSHOP study of the program wrapped up a few months ago and Englesbe hopes the new data will help prove the benefits and even accelerate the adoption of the program.

“I think it’ll become standard of care slowly, but it’s just going to take a long, long time,” Englesbe said. “Hopefully patients will start to expect it, to demand it.”

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