title: Development of a dedicated hepatopancreaticobiliary program in a university hospital system.
abstract: In 2001, a dedicated hepatopancreatobiliary (HPB) cancer program was established at a large, university hospital. Changes included recruitment of specialized HPB faculty, standardization of patient protocols, development of coordinated multidisciplinary research and clinical efforts, collection of prospective surgical outcomes data, and construction of a dedicated cancer hospital. The aim of this study was to evaluate the impact of this program on a university health system including effects on patient volume, surgical volume, outcomes, costs, resident education, and research productivity. Hospital and departmental databases were reviewed for all records pertaining to HPB surgical cases, diagnosis, and financial information over a 6-year period, including 2 years before (1999-2000) and 4 years after (2001-2004) HPB program development. A more than two-fold increase in the number of distinct patients who had HPB diagnosis was seen across all pertinent departments. A five-fold increase in surgical volume was observed. A multidisciplinary approach to care was implemented, leading to a four-fold increase in sharing of patients across departments. Improvements in operative mortality, hospital contribution margin, resident operative experience, and research productivity were observed. The implementation of a dedicated HPB cancer program with coordinated and standardized research, educational, and clinical efforts had measurable institutional benefit.
authors.affiliation: Department of Surgery, Huntsman Cancer Institute, University of Utah School of Medicine, Salt Lake City, Utah 84132, USA.
authors.forename: Steven R
authors.initials: SR
authors.lastname: Granger
authors.forename: Robert E
authors.initials: RE
authors.lastname: Glasgow
authors.forename: Jean
authors.initials: J
authors.lastname: Battaglia
authors.forename: Ruey-Min
authors.initials: RM
authors.lastname: Lee
authors.forename: Courtney
authors.initials: C
authors.lastname: Scaife
authors.forename: Dennis C
authors.initials: DC
authors.lastname: Shrieve
authors.forename: David
authors.initials: D
authors.lastname: Avrin
authors.forename: Sean J
authors.initials: SJ
authors.lastname: Mulvihill
mesh_terms: D002985:Clinical Protocols; D019992:Databases as Topic; D004067:Digestive System Neoplasms / Q000601:surgery*; D017598:Efficiency, Organizational; D005762:Gastroenterology / Q000193:education / Q000458:organization & administration*; D017721:Hospital Costs; D006748:Hospital Departments / Q000458:organization & administration*; D006751:Hospital Information Systems; D006785:Hospitals, University / Q000458:organization & administration*; D006801:Humans; D007396:Internship and Residency; D008505:Medical Staff, Hospital; D010348:Patient Care Team; D010560:Personnel Selection; D016730:Program Development; D015397:Program Evaluation; D011446:Prospective Studies; D012106:Research; D016896:Treatment Outcome; D014589:Utah