title: Assessing national provision of care: variability in bariatric clinical care pathways.
abstract: BACKGROUND
  The American Society for Metabolic and Bariatric Surgery (ASMBS) Quality Improvement and Patient Safety (QIPS) Committee hypothesized that collecting and sharing clinical pathways could provide a valuable resource to new and existing bariatric programs.
  
  
  OBJECTIVE
  To shed light on the variability in practice patterns across the country by analyzing pathways.
  
  
  METHODS
  United States Centers of Excellence METHODS: From June 2014 to April 2015, clinical pathways pertaining to preoperative, intraoperative, and postoperative management of bariatric patients were solicited from the ASMBS executive council (EC), QIPS committee members, and state chapter presidents. Pathways were de-identified and then analyzed based on predetermined metrics pertaining to preoperative, intraoperative, and postoperative care. Concordance and discordance were then analyzed.
  
  
  RESULTS
  In total, 31 pathways were collected; response rate was 80% from the EC, 77% from the QIPS committee, and 21% from state chapter presidents. The number of pathways sent in ranged from 1 to 10 with a median of 3 pathways per individual or institution. The majority of pathways centered on perioperative care (80%). Binary assessment (presence or absence) of variables found a high concordance (defined by greater than 65% of pathways accounting for that parameter) in only 6 variables: nutritional evaluation, psychological evaluation, intraoperative venous thromboembolism (VTE) prophylaxis, utilization of antiemetics in the postoperative period, a dedicated pain pathway, and postoperative laboratory evaluation.
  
  
  CONCLUSIONS
  There is considerable national variation in clinical pathways among practicing bariatric surgeons. Most pathways center on Metabolic and Bariatric Surgery Accredited Quality Improvement Program (MBSAQIP) accreditation parameters, patient satisfaction, or Surgical Care Improvement Protocol (SCIP) measures. These pathways provide a path toward standardization of improved care.
authors.affiliation: Division of Foregut, Bariatric and Advanced GI Surgery, Department of Surgery, Stony Brook University Medical Center, Stony Brook, New York. Electronic address: dana.telem@stonybrookmedicine.edu.
authors.forename: Dana A
authors.initials: DA
authors.lastname: Telem
authors.affiliation: Metabolic and Bariatric Center, Saint Michaels Medical Center, Newark, New Jersey.
authors.forename: Saniea F
authors.initials: SF
authors.lastname: Majid
authors.affiliation: Virginia Tech Carilion School of Medicine, Roanoke, Virginia.
authors.forename: Kinga
authors.initials: K
authors.lastname: Powers
authors.affiliation: Bon Secours Health System, Virginia Division, Bariatric Surgery, Maryview Medical Center, Portsmouth, Virginia.
authors.forename: Eric
authors.initials: E
authors.lastname: DeMaria
authors.affiliation: Division of Bariatric and Minimally Invasive Surgery, Stanford School of Medicine, Stanford, California.
authors.forename: John
authors.initials: J
authors.lastname: Morton
authors.affiliation: Department of Surgery, Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, Massachusetts.
authors.forename: Daniel B
authors.initials: DB
authors.lastname: Jones
mesh_terms: D000046:Academic Medical Centers / Q000592:standards; D050110:Bariatric Surgery / Q000592:standards*; D019091:Critical Pathways / Q000592:standards*; D003695:Delivery of Health Care / Q000592:standards*; D006764:Hospitals, Community / Q000592:standards; D016304:Hospitals, Private / Q000592:standards; D006801:Humans; D007431:Intraoperative Complications / Q000517:prevention & control; D061214:Patient Safety / Q000592:standards; D019990:Perioperative Care / Q000592:standards; D011183:Postoperative Complications / Q000517:prevention & control; D010818:Practice Patterns, Physicians' / Q000592:standards; D058996:Quality Improvement; D011787:Quality of Health Care; D014481:United States
keywords: ASMBS, MBSAQIP; Accreditation; Bariatric surgery; Care maps; Clinical care paths; Pathways; Quality; Quality improvement