Eisenberg Dan, Lohnberg Jessica A, Kubat Eric P, Bates Cheryl C, Greenberg Lauren M, Frayne Susan M
Surgical Service, Palo Alto Veterans Affairs Health Care System, Palo Alto, CA; Department of Surgery, Stanford School of Medicine, Stanford, CA.
Psychology Service, Palo Alto Veterans Affairs Health Care System, Palo Alto, CA.
Surg Obes Relat Dis. 2017 Apr;13(4):600-606. doi: 10.1016/j.soard.2016.11.007. Epub 2016 Nov 15.
Provision of bariatric surgery in the Veterans Health Administration must account for obese veterans' co-morbidity burden and the geographically dispersed location of patients relative to Veterans Affairs (VA) bariatric centers.
To evaluate a collaborative, integrated, interdisciplinary bariatric team of surgeons, bariatricians, psychologists, dieticians, and physical therapists working in a hub-and-spokes care model, for pre- and post-bariatric surgery assessment and management.
This is a description of an interdisciplinary clinic and bariatric program at a VA healthcare system and a report on program evaluation findings. Retrospective data of a prospective database was abstracted. For program evaluation, we abstracted charts to characterize patient data and conducted a patient survey.
Since 2009, 181 veterans have undergone bariatric surgery. Referrals came from 7 western U.S. states. Mean preoperative body mass index was 46 kg/m (maximum 71). Mean age was 53 years, with 33% aged>60 years; 79% were male. Medical co-morbidity included diabetes (70%), hypertension (85%), and lower back or extremity joint pain (84%). A psychiatric diagnosis was present in 58%. At 12 months, follow-up was 81% and percent excess body mass index loss was 50.5%. Among 54 sequential clinic patients completing anonymous surveys, overall satisfaction with the interdisciplinary team approach and improved quality of life were high (98% and 94%, respectively).
The integrated, interdisciplinary team approach using a hub-and-spokes model is well suited to the VA bariatric surgery population, with its heavy burden of medical and mental health co-morbidity and its system of geographically dispersed patients receiving treatment at specialty centers. As the VA seeks to expand the use of bariatric surgery as an option for obese veterans, interdisciplinary models crafted to address case complexity, care coordination, and long-term outcomes should be part of policy planning efforts.
退伍军人健康管理局提供减肥手术时，必须考虑肥胖退伍军人的合并症负担以及患者相对于退伍军人事务部（VA）减肥中心在地理位置上的分散情况。
评估一个由外科医生、减肥专科医生、心理学家、营养师和物理治疗师组成的协作性、综合性、跨学科减肥团队，该团队采用轮辐式护理模式，负责减肥手术前后的评估和管理。
这是对VA医疗系统中一个跨学科诊所和减肥项目的描述，以及关于项目评估结果的报告。提取了前瞻性数据库的回顾性数据。为进行项目评估，我们提取病历以描述患者数据，并开展了一项患者调查。
自2009年以来，181名退伍军人接受了减肥手术。转诊来自美国西部7个州。术前平均体重指数为46kg/m²（最高71）。平均年龄为53岁，33%的患者年龄大于60岁；79%为男性。合并的内科疾病包括糖尿病（70%）、高血压（85%）以及下背部或四肢关节疼痛（84%）。58%的患者有精神疾病诊断。术后12个月时，随访率为81%，超重体重指数损失百分比为50.5%。在54名连续完成匿名调查的门诊患者中，对跨学科团队方法的总体满意度和生活质量改善程度都很高（分别为98%和94%）。
采用轮辐式模式的综合性、跨学科团队方法非常适合VA减肥手术人群，该人群内科和心理健康合并症负担沉重，且患者在专科中心接受治疗，地理分布分散。随着VA寻求扩大将减肥手术作为肥胖退伍军人的一种选择，为应对病例复杂性、护理协调和长期结果而精心设计的跨学科模式应成为政策规划工作的一部分。
