Quality Department, Humanitas Clinical and Research Center -IRCCS, via Manzoni, 56 20089, Rozzano, MI, Italy.
Bariatric Surgery, Humanitas Clinical and Research Center -IRCCS, via Manzoni, 56 20089, Rozzano, MI, Italy.
Obes Surg. 2020 Jul;30(7):2519-2527. doi: 10.1007/s11695-020-04464-w.
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.
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.
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.
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.
减重手术是治疗病态肥胖患者的最有效方法。术后强化康复（ERAS）方案可提高临床结果，但最新文献表明患者的依从性并不完整。本研究旨在展示应用与 ERAS 相关的基于价值的医疗保健（VBHC）策略来提高患者参与度和结果的可行性。
多专业团队根据 ERAS 建议和患者反馈重新设计了流程。通过结构化的患者访谈定义了对患者重要的结果，并在电子临床记录中收集了这些结果。测量了对途径的依从性和护理周期的成本，以证明其可持续性。开发了一个模型以确保其可复制性。
共纳入 2122 名患者。对单一项目的最低依从率为 82%。74%的超重减轻；90%更好地控制合并症；77.5%手术后无疼痛；61%无术后恶心和呕吐。无死亡；总发病率为 1.8%；30 天内再入院和再次手术率为 0.4%。平均住院时间为 2.1 天。患者报告的结果测量指标（PROMs）记录了更高的生产力和生活质量。
多学科团队建立关怀关系，在 ERAS 之上的 VBHC 框架中增加患者的健康福祉，作为以患者为中心的方法，提高了患者对护理途径的参与度和依从性，从而改善了健康结果（临床和 PROMs）。基于价值的模型是可持续和可复制的；它代表了重新设计其他途径的原型，也可能成为其他组织的模型。
