Department of Medicine, New York University School of Medicine, New York, New York, United States.
Medical Center Information Technology, NYU Langone Health, New York, New York, United States.
Appl Clin Inform. 2020 Jan;11(1):95-103. doi: 10.1055/s-0039-1701004. Epub 2020 Feb 5.
Enhanced Recovery after Surgery (ERAS) pathways have been shown to reduce length of stay, but there have been limited evaluations of novel electronic health record (EHR)-based pathways. Compliance with ERAS in real-world settings has been problematic.
This article evaluates a novel ERAS electronic pathway (E-Pathway) activity integrated with the EHR for patients undergoing elective colorectal surgery.
We performed a retrospective cohort study of surgical patients age ≥ 18 years hospitalized from March 1, 2013 to August 31, 2016. The primary cohort consisted of patients admitted for elective colon surgery. We also studied a control group of patients undergoing other elective procedures. The E-Pathway was implemented on March 2, 2015. The primary outcome was variable costs per case. Secondary outcomes were observed to expected length of stay and 30-day readmissions.
We included 823 (470 and 353 in the pre- and postintervention, respectively) colon surgery patients and 3,415 (1,819 and 1,596 in the pre- and postintervention) surgical control patients in the study. Among the colon surgery cohort, there was statistically significant ( = 0.040) decrease in costs of 1.28% (95% confidence interval [CI] 0.06-2.48%) per surgical encounter per month over the 18-month postintervention period, amounting to a total savings of $2,730 per patient at the 1-year postintervention period. The surgical control group had a nonsignificant ( = 0.231) decrease in monthly costs of 0.57% (95% CI 1.51 to - 0.37%) postintervention. For the 30-day readmission rates, there were no statistically significant changes in either cohort.
Our study is the first to report on the reduced costs after implementation of a novel sophisticated E-Pathway for ERAS. E-Pathways can be a powerful vehicle to support ERAS adoption.
手术康复增强（ERAS）路径已被证明可以缩短住院时间，但对新型电子健康记录（EHR）为基础的路径的评估有限。在实际环境中，ERAS 的遵守情况一直存在问题。
本文评估了一种用于择期结直肠手术患者的新型 ERAS 电子路径（E-Pathway）与 EHR 的整合。
我们对 2013 年 3 月 1 日至 2016 年 8 月 31 日期间住院的年龄≥18 岁的手术患者进行了回顾性队列研究。主要队列由接受择期结肠手术的患者组成。我们还研究了接受其他择期手术的对照组患者。E-Pathway 于 2015 年 3 月 2 日实施。主要结果是每个病例的可变成本。次要结果是观察到的预期住院时间和 30 天再入院率。
我们纳入了 823 例（干预前 470 例，干预后 353 例）结肠手术患者和 3415 例（干预前 1819 例，干预后 1596 例）手术对照组患者。在结肠手术队列中，干预后 18 个月内每月手术费用降低了 1.28%（95%置信区间 [CI] 0.06-2.48%），这意味着在干预后 1 年每个患者节省了 2730 美元。对照组每月成本降低了 0.57%（95%置信区间 1.51-0.37%），但差异无统计学意义（ = 0.231）。在 30 天再入院率方面，两组均无统计学意义的变化。
我们的研究首次报告了实施新型复杂 ERAS 电子路径后成本降低的情况。E-Pathway 可以成为支持 ERAS 采用的有力工具。
