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ABSTRACT & COMMENTARY
An outcomes management program was launched by Morris et al in June 1994 based on the elimination of wasteful or ineffective therapies through the systematic development of practice guidelines and collaborative care paths with concomitant definition of desired outcomes. Over three months, care paths were developed for their most common surgical procedures. A matched control outcomes study was undertaken for the most commonly performed gynecologic oncology procedure: total abdominal hysterectomy and oophorectomy with pelvic and para-aortic node sampling for endometrial cancer. Thirty consecutive women treated on the care path were compared with 29 matched controls from the period preceding care-path planning. Patient satisfaction with care-path treatment was assessed by a survey sent two weeks after discharge. Median length of hospital stay decreased significantly from six days before care-path planning to four days after care-path implementation (P < 0.001). Median laboratory costs decreased by 74%, medication costs by 35%, room costs by 29%, and total hospital costs by 20%. Incremental improvements were observed during care-path planning. There were no readmissions for complications in the care-path group. According to the survey results, patient satisfaction with care was very high among care-path patients. The authors conclude that a physician-driven outcomes-management program in an academic setting permits the delivery of high-quality care and supports outcomes research while decreasing costs.
Managed care has several undesirable aspects; one of the few positive aspects is that health care reform has caused most physicians and institutions to reexamine their methodology of delivery of medical care. To meet this challenge at the University of Texas M.D. Anderson Cancer Center, a pilot program in outcomes management was initiated. The primary goal of this program was to provide tools to decrease the cost of patient care while maintaining or increasing quality, and to measure both cost and quality of care. The foundation of this program was practice guidelines and collaborative care paths. As illustrated by this simple study, length of hospital stay and cost were significantly reduced while maintaining quality and patient satisfaction. An identical model is currently being employed for several other gynecologic oncology surgical procedures, including radical hysterectomy and bilateral pelvic lymphadenectomy, vulvar cancer surgery, and cytoreductive surgery for ovarian cancer. As is underscored by the authors, to be successful, it is essential that an outcomes management program be physician-driven. However, it is also critical that the development of pathways and guidelines be a multidisciplinary approach, with appropriate input from nurses, young physicians in training, nutritionists, and other health care personnel as deemed necessary. Such systematic approaches will serve to strengthen the delivery of patient care while eliminating waste.