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Etges APBS, Stefani LPC, Vrochides D, Nabi J, Polanczyk CA, Urman RD. A Standardized Framework for Evaluating Surgical Enhanced Recovery Pathways: A Recommendations Statement from the TDABC in Health-care Consortium. JOURNAL OF HEALTH ECONOMICS AND OUTCOMES RESEARCH 2021; 8:116-124. [PMID: 34222551 PMCID: PMC8225410 DOI: 10.36469/001c.24590] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Accepted: 06/01/2021] [Indexed: 06/13/2023]
Abstract
Background: Innovative methodologies to redesign care delivery are being applied to increase value in health care, including the creation of enhanced recovery pathways (ERPs) for surgical patients. However, there is a lack of standardized methods to evaluate ERP implementation costs. Objectives: This Recommendations Statement aims to introduce a standardized framework to guide the economic evaluation of ERP care-design initiatives, using the Time-Driven Activity-Based Costing (TDABC) methodology. Methods: We provide recommendations on using the proposed framework to support the decision-making processes that incorporate ERPs. Since ERPs are usually composed of activities distributed throughout the patient care pathway, the framework can demonstrate how the TDABC may be a valuable method to evaluate the incremental costs of protocol implementation. Our recommendations are based on the review of available literature and expert opinions of the members of the TDABC in Healthcare Consortium. Results: The ERP framework, composed of 11 steps, was created describing how the techniques and methods can be applied to evaluate the economic impact of an ERP and guide health-care leaders to optimize the decision-making process of incorporating ERPs into health-care settings. Finally, six recommendations are introduced to demonstrate that using the suggested framework could increase value in ERP care-design initiatives by reducing variability in care delivery, educating multidisciplinary teams about value in health, and increasing transparency when managing surgical pathways. Conclusions: Our proposed standardized framework can guide decisions and support measuring improvements in value achieved by incorporating the perioperative redesign protocols.
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Affiliation(s)
- Ana Paula B S Etges
- National Institute of Science and Technology for Health Technology Assessment (IATS) - CNPq/Brazil (project: 465518/2014-1), Porto Alegre, RS, Brazil; School of Technology, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, Brazil; Postgraduate Program in Epidemiology, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | | | - Dionisios Vrochides
- Division of Hepatobiliary & Pancreas Surgery, Carolinas Medical Center, Atrium Health, Charlotte, NC, USA
| | - Junaid Nabi
- Harvard University, Harvard Business School, Boston, MA, USA
| | - Carisi Anne Polanczyk
- National Institute of Science and Technology for Health Technology Assessment (IATS) - CNPq/Brazil (project: 465518/2014-1), Porto Alegre, RS, Brazil; Postgraduate Program in Epidemiology, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Richard D Urman
- National Institute of Science and Technology for Health Technology Assessment (IATS) - CNPq/Brazil (project: 465518/2014-1), Porto Alegre, RS, Brazil; School of Technology, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, Brazil; Postgraduate Program in Epidemiology, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
- Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
- Division of Hepatobiliary & Pancreas Surgery, Carolinas Medical Center, Atrium Health, Charlotte, NC, USA
- Harvard University, Harvard Business School, Boston, MA, USA
- National Institute of Science and Technology for Health Technology Assessment (IATS) - CNPq/Brazil (project: 465518/2014-1), Porto Alegre, RS, Brazil; Postgraduate Program in Epidemiology, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
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Abstract
For over 20 years enhanced recovery protocols (ERPs) have been used to decrease the physiologic stress and inflammation of surgery using evidence-based principles. ERPs include optimizing patient preparation, creating less trauma using minimally invasive anesthetic and surgical techniques, and regular audit of outcomes. A critical aspect of ERPs is patient engagement in all phases of care, which facilitates effective team function and focused oversight of patient flow through the system. Counseling extends beyond traditional review of surgical risks and benefits, by creating clear daily patient goals, establishing pain management plans, optimizing nutrition, and defining criteria for discharge. The patient and family are provided written and visual media resources to review. This counseling and education clearly outlines the bidirectional expectations, ensures preparedness, and empowers the patient and family by explaining the logic surrounding many of the ERP interventions. The patient and family are, in turn, activated as key stakeholders in the process and have a shared vision with the healthcare team. Most patients enjoy being considered partners and agents in their own healthcare. ERPs facilitate an optimal surgical experience that can improve patient satisfaction, outcomes, and value.
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Affiliation(s)
- Kurt F Heiss
- Division of Pediatric Surgery, Department of Surgery, Emory University School of Medicine and Children's Healthcare of Atlanta, Atlanta, GA, USA
| | - Mehul V Raval
- Division of Pediatric Surgery, Department of Surgery, Emory University School of Medicine and Children's Healthcare of Atlanta, Atlanta, GA, USA.
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Affiliation(s)
- Christopher W Seder
- Department of Cardiovascular and Thoracic Surgery, Rush University Medical Center, Chicago, IL, USA
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