Long-term Objectives: The project is the first in a series for the design, development, initial testing, dissemination and implementation, and evaluation (employing a large-scale pragmatic trial) of an information technology-based, patient-centric, preoperative, surgical risk assessment and decision support tool. We term this patient-centric tool, the SUrgical Risk Preoperative Assessment System (SURPAS). Our long-term goal over the next five or more years is to demonstrate that the preoperative provision of quantitative estimates of the risk of adverse operative outcomes to the surgical team, patient, and relevant hospital personnel leads to improved operative outcomes and reduces cost. If successful this approach will represent a paradigm shift in the way surgical risk is determined and shared with patients and providers preoperatively. Specific Aim 1: Apply an existing theoretical model of health information technology usage behavior to engage stakeholders, who include representatives of: a) Department of Surgery and University of Colorado Hospital (UCH) administrative leadership; b) Surgical teams composed of physicians, nurses, physician assistants, etc.; and c) Surgical patients. A combination of group meetings, structured interviews and focus groups will be conducted to: a) Identify facilitators and barriers to SURPAS implementation; b) Design and implement SURPAS to support existing care and quality improvement programs; c) Be able to communicate effectively SURPAS goals and design to hospital leadership and staff; and d) Effectively communicate risk of proposed surgery to patients. Specific Aim 2: Develop, implement on a limited basis, and refine SURPAS at UCH. Tasks include: a) Develop risk models to predict outcomes, which are parsimonious in their data requirements (largely completed with internal funding); b) Identify, map and validate the predictive variables available in the UCH Epic electronic health record (EHR); c) Develop software tools for real-time extraction of these data, facilitate entry by the surgical team of a limited set of key predictive variables not available in the EHR, and package these data as a statement of operative risk for inclusion in the preoperative note; d) Employ the AHRQ- supported Patient Education Materials Assessment Tool to maximize patient understandability and actionability of the CDS in SURPAS; e) Implement initial delivery methods to providers and patients at the point-of-care; and f) Monitor SURPAS CDS application, data integrity, performance and efficacy. Specific Aim 3: Towards our long-term goal stated above, we will use information generated in the second year of the present application to develop a dissemination and implementation (D & I) application. This will be conducted within the University of Colorado Health System, a partnership of three major health systems formed to enhance care in the Rocky Mountain Front Range region. This D & I study will then be followed by a large-scale pragmatic randomized clinical trial to determine if SURPAS improves patient outcomes and reduces health care costs.