• J. Am. Coll. Surg. · May 2015

    Observational Study

    Feasibility and impact of an evidence-based program for gastric bypass surgery.

    • Anthony T Petrick, Christopher D Still, Craig G Wood, Mary Anne Vitunac, Mathew Plank, Linda McGrail, William E Strodel, Jon D Gabrielsen, Joanne Rogers, and Peter Benotti.
    • Department of Surgery, Geisinger Medical Center, Danville, PA. Electronic address: atpetrick@geisinger.edu.
    • J. Am. Coll. Surg.. 2015 May 1;220(5):855-62.

    BackgroundHealth 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 DesignA 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.ResultsTwo 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.ConclusionsStandardization of evidence-based care delivery for Roux-en-Y gastric bypass was feasible and reliable delivery of this pathway improved clinical outcomes.Copyright © 2015 American College of Surgeons. Published by Elsevier Inc. All rights reserved.

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