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.
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.
Authors: Ola S Ahmed; Ailín C Rogers; Jarlath C Bolger; Achille Mastrosimone; William B Robb Journal: J Gastrointest Surg Date: 2018-02-27 Impact factor: 3.452
Authors: Ryan D Horsley; Ellen D Vogels; Daaron A P McField; David M Parker; Charles Medico; James Dove; Marcus Fluck; Jon D Gabrielsen; Michael R Gionfriddo; Anthony T Petrick Journal: Obes Surg Date: 2019-02 Impact factor: 4.129
Authors: Robert M Cunningham; Katherine T Jones; Jason E Kuhn; James T Dove; Ryan D Horsley; Mustapha Daouadi; Jon D Gabrielsen; Anthony T Petrick; David M Parker Journal: Obes Surg Date: 2020-11-23 Impact factor: 4.129
Authors: Amlish B Gondal; Chiu-Hsieh Hsu; Federico Serrot; Andrea Rodriguez-Restrepo; Audriana N Hurbon; Carlos Galvani; Iman Ghaderi Journal: Obes Surg Date: 2019-02 Impact factor: 4.129
Authors: Piotr Małczak; Michał Wysocki; Hanna Twardowska; Alicja Dudek; Justyna Tabiś; Piotr Major; Magdalena Pisarska; Michał Pędziwiatr Journal: Obes Surg Date: 2020-04 Impact factor: 4.129
Authors: Piotr Małczak; Magdalena Pisarska; Major Piotr; Michał Wysocki; Andrzej Budzyński; Michał Pędziwiatr Journal: Obes Surg Date: 2017-01 Impact factor: 4.129