title: Meeting the challenge of managed care through clinical pathways for bariatric surgery.
abstract: BACKGROUND
  The 1990s will bring sweeping changes in managed care and capitation. Health care providers are continually searching for new ways to improve the quality of patient-care outcomes in the obese. Improving clinical care by promoting the use of processes that have been proved to yield optimal outcomes has become a powerful strategy for measuring the value of services provided.
  
  
  METHODS
  To address this cost/quality paradox, an optimal care path (OCP) was developed as a guideline for all patients undergoing gastric bypass or laparoscopic adjustable gastric banding. A transdisciplinary team developed the OCP, preprinted orders, discharge home instruction sheet, and daily guidelines for patients. All patients were provided with OCPs from July 1995 to September 1997.
  
  
  RESULTS
  Length of stay decreased from 6.5 days to 5.4 days (16.9%); the average total charges decreased 17.6%, or $2,683; the percentage of wound infections decreased; and communication between, and collaboration of, interdisciplinary team members increased across the continuum of care.
  
  
  CONCLUSIONS
  The study suggests that the use of OCP does not impair quality of care and can produce significant cost savings to a health care facility.
authors.affiliation: Department of Perioperative Services, Pitt County Memorial Hospital, Greenville, NC, USA.
authors.forename: A D
authors.initials: AD
authors.lastname: Rouse
authors.forename: B L
authors.initials: BL
authors.lastname: Tripp
authors.forename: S
authors.initials: S
authors.lastname: Shipley
authors.forename: W
authors.initials: W
authors.lastname: Pories
authors.forename: P
authors.initials: P
authors.lastname: Cunningham
authors.forename: K
authors.initials: K
authors.lastname: MacDonald
mesh_terms: D019091:Critical Pathways; D013505:Digestive System Surgical Procedures / Q000451:nursing; D006801:Humans; D008329:Managed Care Programs / Q000592:standards*; D009767:Obesity, Morbid / Q000451:nursing / Q000601:surgery*; D010348:Patient Care Team; D011785:Quality Assurance, Health Care / Q000379:methods; D014481:United States