1
|
Letica-Kriegel AS, Rosen R, McNeil N, Thompson E, James M, Broach V, Roche KL, Riportella M, Ng S, Bernal C, Vaynrub M, Downey R, Voigt L, Epstein AS, Nelson J, Goldfrank D, Nash GM. Development and perception of surgery-specific goals of care discussions in the preoperative setting: A learning pilot. J Surg Oncol 2024; 129:1384-1389. [PMID: 38549286 DOI: 10.1002/jso.27632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2024] [Accepted: 03/05/2024] [Indexed: 05/31/2024]
Abstract
BACKGROUND Goals of care discussions are infrequently documented in the preoperative period. Furthermore, documentation does not consistently address what matters most to patients, although patient values (PV) are central to person-centered care. METHODS A multidisciplinary working group was formed. An electronic note comprised of (1) topics of discussion, (2) PV, and (3) advance care planning (ACP), was created and embedded into existing note templates for Gynecologic Surgical Oncology. Surgeons and advanced practice providers (APPs) were educated to conduct and document these conversations in preoperative clinic for patients undergoing cancer surgery for a pilot period. Data were collected regarding usage of the template. Focus groups with surgeons, APPs, and patients were conducted. Qualitative analysis was performed on transcripts. RESULTS During the pilot, 7 surgeon/APP teams utilized the template on a total of 55 notes. Average number of notes completed per surgeon was 7.8 (SD 8.5). Forty-six notes (84%) included topics of discussion, 15 (27%) included PV, 4 (7%) included ACP. Qualitative analysis of focus group transcripts revealed that clinicians and patients perceived the initiative to be useful and important, although implementation barriers were identified. CONCLUSION Creating a surgery-specific GOC template is feasible. Iterative revisions are needed to increase utility in clinic workflows.
Collapse
Affiliation(s)
| | - Roni Rosen
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Nita McNeil
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Errika Thompson
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Monique James
- Department of Anesthesiology and Critical Care, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Vance Broach
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Kara Long Roche
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Michaela Riportella
- Clinical Informatics, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Susan Ng
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Camila Bernal
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Max Vaynrub
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Robert Downey
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Louis Voigt
- Department of Anesthesiology and Critical Care, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Andrew S Epstein
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Judith Nelson
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Deborah Goldfrank
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Garrett M Nash
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| |
Collapse
|
2
|
Newton D, Bader AM. Value-Based Health Care in Perioperative Medicine: Process Maps and Costing to Determine Best Practices. Anesthesiol Clin 2024; 42:75-86. [PMID: 38278594 DOI: 10.1016/j.anclin.2023.08.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2024]
Abstract
Perioperative care in the United States is largely based on current fee-for-service models. Fee-for-service models are not based on the true cost of services provided, charges do not equal costs, and reimbursement varies based on insurer. Value-based health care is defined as patient-centered outcomes over cost of providing these services. Process mapping and time-driven activity-based costing can be used to define actual cost of services provided. Outcomes after discharge can be measured, so that the overall value of care provided can be assessed and improved based on the outcomes and costs identified.
Collapse
Affiliation(s)
- David Newton
- Department of Anesthesiology, Vanderbilt University Medical Center, 1211 Medical Center Drive, Nashville, TN 37232, USA
| | - Angela M Bader
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA.
| |
Collapse
|