Value-Based Healthcare and Enhanced Recovery After Surgery Implementation in a High-Volume Bariatric Center in Italy
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ORIGINAL CONTRIBUTIONS
Value-Based Healthcare and Enhanced Recovery After Surgery Implementation in a High-Volume Bariatric Center in Italy Giulia Goretti 1
&
Giuseppe M. Marinari 2 & Elena Vanni 3 & Chiara Ferrari 4
# The Author(s) 2020
Abstract Background Bariatric surgery is the most effective treatment for patients affected by morbid obesity. The Enhanced Recovery After Surgery (ERAS) protocol increases clinical outcomes, but the most recent literature shows incomplete patients’ adherence. This study aims to demonstrate the feasibility of applying a Value-Based Healthcare (VBHC) strategy associated with ERAS to increase patients’ engagement and outcomes. Method A multiprofessional team redesigned the process considering ERAS recommendations and patients’ feedbacks. Outcomes that matter to patients were defined with structured patients’ interviews and collected in the electronic clinical record. Adherence to the pathway and the cost of the cycle of care were measured to demonstrate sustainability. A model was developed to grant its replicability. Results A total of 2.122 patients were included. The lowest adherence to the protocol for a single item was 82%. 74% of excess weight loss; 90% better comorbidities control; 77.5% had no pain after surgery; 61% no postoperative nausea and vomiting. Zero mortality; 1.8% overall morbidity; 0.4% readmission and reoperation rate within 30 days. The average length of stay is 2.1 days. Patient-Reported Outcome Measures (PROMs) documented increased productivity and quality of life. Conclusion Building a caring relationship by a multidisciplinary team, adding patient wellness in a VBHC framework on top of ERAS as a patient-centered approach, increases patients’ engagement and adherence to the pathway of care, resulting in better health outcomes (clinical and PROMs). The Value-Based Model is sustainable and replicable; it represents the prototype for redesigning other pathways and may become a model for other organizations. Keywords Bariatric surgery . Value-based healthcare . Patient-centered care . Patient wellness . Performance measures . Quality improvement
Introduction Morbid obesity is an increasingly prevalent condition worldwide. It is a chronic disease associated with long-term
* Giulia Goretti [email protected] 1
Quality Department, Humanitas Clinical and Research Center – IRCCS, via Manzoni, 56 20089 Rozzano, MI, Italy
2
Bariatric Surgery, Humanitas Clinical and Research Center –IRCCS, via Manzoni, 56 20089 Rozzano, MI, Italy
3
Performance audit, Humanitas Clinical and Research Center – IRCCS, via Manzoni, 56 20089 Rozzano, MI, Italy
4
Anesthesia, Humanitas Clinical and Research Center –IRCCS, via Manzoni, 56 20089 Rozzano, MI, Italy
comorbidities (i.e., diabetes, cardiac and respiratory diseases, and malignant neoplasms), reduced overall survival (higher any cause-any age mortality), mental illness (i.e., depression and anxiety), and poorer quality of life [1]. Morbid obesity has become a serious international public health concern with a con
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