title: A study of efficacy and cost-effectiveness of guided imagery as a portable, self-administered, presurgical intervention delivered by a health plan.
abstract: BACKGROUND
  Previous research indicates that immersive, mind-body interventions can improve the quality of a patient's surgical experience and clinical outcomes.
  
  
  OBJECTIVE
  To describe the Blue Shield of California Presurgical Guided Imagery Program, assess its impact on surgical outcomes, patient satisfaction, and cost savings.
  
  
  METHODS
  Analysis of survey data conducted pre- and post-surgery among 905 eligible health plan members. Retrospective analysis of medical claims for a subset of 126 hysterectomy patients was compared with that of similar patients who did not use guided imagery for differences in length of stay and charges billed.
  
  
  RESULTS
  The intervention yielded an adoption rate of 74%. Patients who used the guided imagery intervention reported significantly reduced anxiety and high levels of satisfaction. A trend toward shorter hospital stays (8% reduction, P=.07) was also observed in the imagery group, as well as reduced pharmaceutical costs (14% reduction, P=.181). In total, there was a 14% reduction in mean total charges billed per procedure in the imagery patients, amounting to an average savings of $2003 per procedure. Although it was not possible to isolate differential cost of lab and imaging fees for the purposes of this study, it is likely these factors played a part in the billing differential as well.
  
  
  CONCLUSIONS
  Health plans are well positioned to deliver guided imagery tools for patient self-management prior to scheduled surgery. While mind-body interventions are increasingly linked to cost savings and improved outcomes in a variety of clinical settings, a randomized controlled trial should be conducted to firmly establish their efficacy.
authors.affiliation: Blue Shield of California Foundation, USA.
authors.forename: Deborah
authors.initials: D
authors.lastname: Schwab
authors.forename: Dana
authors.initials: D
authors.lastname: Davies
authors.forename: Tracy
authors.initials: T
authors.lastname: Bodtker
authors.forename: Lucy
authors.initials: L
authors.lastname: Anaya
authors.forename: Keren
authors.initials: K
authors.lastname: Johnson
authors.forename: Maria
authors.initials: M
authors.lastname: Chaves
mesh_terms: D001007:Anxiety / Q000517:prevention & control*; D002140:California; D003362:Cost-Benefit Analysis; D017558:Elective Surgical Procedures / Q000523:psychology*; D005260:Female; D017048:Health Care Costs; D006801:Humans; D007044:Hysterectomy / Q000523:psychology*; D019018:Imagery, Psychotherapy / Q000191:economics; D007902:Length of Stay; D008297:Male; D017063:Outcome Assessment, Health Care; D012189:Retrospective Studies; D012648:Self Care