Feasibility and Impact of an Evidence-Based Program for Gastric Bypass Surgery - 22/04/15
Abstract |
Background |
Health care in the United States is expensive and quality is variable. The aim of this study was to investigate whether our integrated health system, composed of academic hospitals, a practice plan, and a managed care payer, could reliably implement an evidence-based program for gastric bypass surgery. A secondary aim was to evaluate the impact of the program on clinical outcomes.
Study Design |
A standardized program for delivery of clinical best-practice elements for patients undergoing initial open or laparoscopic Roux-en-Y gastric bypass was implemented in 2008. Best-practice elements were embedded into the workflow. The best-practice elements were refined after reviewing failures observed during the early implementation period. The study period was divided into 3 groups: group α = year preceding program implementation (control), group β = first year of implementation (unreliable), and group Ω = 2nd to 4th years of implementation (reliable). Outcomes data were collected for all patients who had undergone Roux-en-Y gastric bypass between May 2008 and April 2012 and were compared with a control group from the preceding year using multiple logistic regression analysis.
Results |
Two thousand and sixty-one patients were studied, with no significant demographic differences between study groups. Best-practice elements delivery was 40% in group β, but was >90% for group Ω (p < 0.001). Length of stay for group α was 3.5 days and improved to 2.2 days (p < 0.001) for group Ω. Complications and readmission rates improved considerably with reliable delivery of best-practice elements.
Conclusions |
Standardization of evidence-based care delivery for Roux-en-Y gastric bypass was feasible and reliable delivery of this pathway improved clinical outcomes.
Le texte complet de cet article est disponible en PDF.Abbreviations and Acronyms : BPE, EMR, LOS, LRYGB, OR, ORYGB, RYGB
Plan
Disclosure Information: Nothing to disclose. |
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Geisinger IRRB Approval #2013-0478. |
Vol 220 - N° 5
P. 855-862 - mai 2015 Retour au numéroBienvenue sur EM-consulte, la référence des professionnels de santé.
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