title: Feasibility and impact of an evidence-based program for gastric bypass surgery.
abstract: BACKGROUND
  Health care in the United States is expensive and quality is variable. The aim of this study was to investigate whether our integrated health system, composed of academic hospitals, a practice plan, and a managed care payer, could reliably implement an evidence-based program for gastric bypass surgery. A secondary aim was to evaluate the impact of the program on clinical outcomes.
  
  
  METHODS
  A standardized program for delivery of clinical best-practice elements for patients undergoing initial open or laparoscopic Roux-en-Y gastric bypass was implemented in 2008. Best-practice elements were embedded into the workflow. The best-practice elements were refined after reviewing failures observed during the early implementation period. The study period was divided into 3 groups: group α = year preceding program implementation (control), group β = first year of implementation (unreliable), and group Ω = 2nd to 4th years of implementation (reliable). Outcomes data were collected for all patients who had undergone Roux-en-Y gastric bypass between May 2008 and April 2012 and were compared with a control group from the preceding year using multiple logistic regression analysis.
  
  
  RESULTS
  Two thousand and sixty-one patients were studied, with no significant demographic differences between study groups. Best-practice elements delivery was 40% in group β, but was >90% for group Ω (p < 0.001). Length of stay for group α was 3.5 days and improved to 2.2 days (p < 0.001) for group Ω. Complications and readmission rates improved considerably with reliable delivery of best-practice elements.
  
  
  CONCLUSIONS
  Standardization of evidence-based care delivery for Roux-en-Y gastric bypass was feasible and reliable delivery of this pathway improved clinical outcomes.
authors.affiliation: Department of Surgery, Geisinger Medical Center, Danville, PA. Electronic address: atpetrick@geisinger.edu.
authors.forename: Anthony T
authors.initials: AT
authors.lastname: Petrick
authors.affiliation: Department of Surgery, Geisinger Medical Center, Danville, PA.
authors.forename: Christopher D
authors.initials: CD
authors.lastname: Still
authors.affiliation: Department of Surgery, Geisinger Medical Center, Danville, PA.
authors.forename: Craig G
authors.initials: CG
authors.lastname: Wood
authors.affiliation: Department of Surgery, Geisinger Medical Center, Danville, PA.
authors.forename: Mary Anne
authors.initials: MA
authors.lastname: Vitunac
authors.affiliation: Department of Surgery, Geisinger Medical Center, Danville, PA.
authors.forename: Mathew
authors.initials: M
authors.lastname: Plank
authors.affiliation: Department of Surgery, Geisinger Medical Center, Danville, PA.
authors.forename: Linda
authors.initials: L
authors.lastname: McGrail
authors.affiliation: Department of Surgery, Geisinger Medical Center, Danville, PA.
authors.forename: William E
authors.initials: WE
authors.lastname: Strodel
authors.affiliation: Department of Surgery, Geisinger Medical Center, Danville, PA.
authors.forename: Jon D
authors.initials: JD
authors.lastname: Gabrielsen
authors.affiliation: Department of Surgery, Geisinger Medical Center, Danville, PA.
authors.forename: Joanne
authors.initials: J
authors.lastname: Rogers
authors.affiliation: Department of Surgery, Geisinger Medical Center, Danville, PA.
authors.forename: Peter
authors.initials: P
authors.lastname: Benotti
mesh_terms: D000328:Adult; D019033:Delivery of Health Care, Integrated / Q000592:standards*; D019317:Evidence-Based Medicine; D005240:Feasibility Studies; D005260:Female; D015390:Gastric Bypass / Q000379:methods / Q000592:standards*; D006801:Humans; D010535:Laparoscopy / Q000379:methods / Q000592:standards*; D007902:Length of Stay / Q000706:statistics & numerical data; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000601:surgery*; D010359:Patient Readmission / Q000706:statistics & numerical data; D011183:Postoperative Complications / Q000453:epidemiology; D016896:Treatment Outcome