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Appl Clin Inform 2020; 11(01): 095-103
DOI: 10.1055/s-0039-1701004
Research Article
Georg Thieme Verlag KG Stuttgart · New York

The Financial and Clinical Impact of an Electronic Health Record Integrated Pathway in Elective Colon Surgery

Jonathan S. Austrian
1   Department of Medicine, New York University School of Medicine, New York, New York, United States
2   Medical Center Information Technology, NYU Langone Health, New York, New York, United States
,
Frank Volpicelli
1   Department of Medicine, New York University School of Medicine, New York, New York, United States
,
Simon Jones
3   Department of Population Health, New York University School of Medicine, New York, New York, United States
,
Mitchell A. Bernstein
4   Department of Surgery, New York University School of Medicine, New York, New York, United States
,
Jane Padikkala
3   Department of Population Health, New York University School of Medicine, New York, New York, United States
,
Ashley Bagheri
3   Department of Population Health, New York University School of Medicine, New York, New York, United States
,
Saul Blecker
1   Department of Medicine, New York University School of Medicine, New York, New York, United States
3   Department of Population Health, New York University School of Medicine, New York, New York, United States
› Author Affiliations
Further Information

Publication History

20 July 2019

12 December 2019

Publication Date:
05 February 2020 (online)

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Abstract

Background Enhanced Recovery after Surgery (ERAS) pathways have been shown to reduce length of stay, but there have been limited evaluations of novel electronic health record (EHR)-based pathways. Compliance with ERAS in real-world settings has been problematic.

Objective This article evaluates a novel ERAS electronic pathway (E-Pathway) activity integrated with the EHR for patients undergoing elective colorectal surgery.

Methods We performed a retrospective cohort study of surgical patients age ≥ 18 years hospitalized from March 1, 2013 to August 31, 2016. The primary cohort consisted of patients admitted for elective colon surgery. We also studied a control group of patients undergoing other elective procedures. The E-Pathway was implemented on March 2, 2015. The primary outcome was variable costs per case. Secondary outcomes were observed to expected length of stay and 30-day readmissions.

Results We included 823 (470 and 353 in the pre- and postintervention, respectively) colon surgery patients and 3,415 (1,819 and 1,596 in the pre- and postintervention) surgical control patients in the study. Among the colon surgery cohort, there was statistically significant (p = 0.040) decrease in costs of 1.28% (95% confidence interval [CI] 0.06–2.48%) per surgical encounter per month over the 18-month postintervention period, amounting to a total savings of $2,730 per patient at the 1-year postintervention period. The surgical control group had a nonsignificant (p = 0.231) decrease in monthly costs of 0.57% (95% CI 1.51 to – 0.37%) postintervention. For the 30-day readmission rates, there were no statistically significant changes in either cohort.

Conclusion Our study is the first to report on the reduced costs after implementation of a novel sophisticated E-Pathway for ERAS. E-Pathways can be a powerful vehicle to support ERAS adoption.

Keywords

clinical pathways - clinical decision support - surgery - cost reduction and return on investment - evaluation

Protection of Human and Animal Subjects

The study was performed in compliance with the World Medical Association Declaration of Helsinki on Ethical Principles for Medical Research Involving Human Subjects and we received ethics approval from the NYU Langone Health Institutional Review Board.


Supplementary Material

 

  • References

  • 1 Basse L, Thorbøl JE, Løssl K, Kehlet H. Colonic surgery with accelerated rehabilitation or conventional care. Dis Colon Rectum 2004; 47 (03) 271-277
    CrossrefPubMedGoogle Scholar
  • 2 Khoo CK, Vickery CJ, Forsyth N, Vinall NS, Eyre-Brook IA. A prospective randomized controlled trial of multimodal perioperative management protocol in patients undergoing elective colorectal resection for cancer. Ann Surg 2007; 245 (06) 867-872
    CrossrefPubMedGoogle Scholar
  • 3 Muller S, Zalunardo MP, Hubner M, Clavien PA, Demartines N. ; Zurich Fast Track Study Group. A fast-track program reduces complications and length of hospital stay after open colonic surgery. Gastroenterology 2009; 136 (03) 842-847
    CrossrefPubMedGoogle Scholar
  • 4 Spanjersberg WR, Reurings J, Keus F, van Laarhoven CJ. Fast track surgery versus conventional recovery strategies for colorectal surgery. Cochrane Database Syst Rev 2011; (02) CD007635
    PubMedGoogle Scholar
  • 5 Eskicioglu C, Forbes SS, Aarts M-A, Okrainec A, McLeod RS. Enhanced recovery after surgery (ERAS) programs for patients having colorectal surgery: a meta-analysis of randomized trials. J Gastrointest Surg 2009; 13 (12) 2321-2329
    CrossrefPubMedGoogle Scholar
  • 6 Group EC. ; ERAS Compliance Group. The impact of enhanced recovery protocol compliance on elective colorectal cancer resection: results from an international registry. Ann Surg 2015; 261 (06) 1153-1159
    CrossrefPubMedGoogle Scholar
  • 7 Gustafsson UO, Hausel J, Thorell A, Ljungqvist O, Soop M, Nygren J. ; Enhanced Recovery After Surgery Study Group. Adherence to the enhanced recovery after surgery protocol and outcomes after colorectal cancer surgery. Arch Surg 2011; 146 (05) 571-577
    CrossrefPubMedGoogle Scholar
  • 8 Gooch P, Roudsari A. Computerization of workflows, guidelines, and care pathways: a review of implementation challenges for process-oriented health information systems. J Am Med Inform Assoc 2011; 18 (06) 738-748
    CrossrefPubMedGoogle Scholar
  • 9 Rodriguez-Loya S, Aziz A, Chatwin C. A service oriented approach for guidelines-based clinical decision support using BPMN. Stud Health Technol Inform 2014; 205: 43-47
    PubMedGoogle Scholar
  • 10 Rotter T, Kinsman L, James E. , et al. Clinical pathways: effects on professional practice, patient outcomes, length of stay and hospital costs. Cochrane Database Syst Rev 2010; (03) CD006632
    PubMedGoogle Scholar
  • 11 Chatfield SC, Volpicelli FM, Adler NM. , et al. Bending the cost curve: time series analysis of a value transformation programme at an academic medical centre. BMJ Qual Saf 2019; 28 (06) 449-458
    CrossrefPubMedGoogle Scholar
  • 12 Vizient: Clinical Data Base/Resource Manager v 8.12.0.11. Irving, TX: Vizient; 2018. . Updated 2018. Available at: https://www.vizientinc.com/our-solutions/clinical-solutions/clinical-data-base . Accessed April 15, 2019
    Google Scholar
  • 13 ACS NSQIP Surgical Risk Calculator. 2019. Available at: https://riskcalculator.facs.org/RiskCalculator . Accessed October 1, 2019
    PubMed
  • 14 Campbell SM, Reeves D, Kontopantelis E, Sibbald B, Roland M. Effects of pay for performance on the quality of primary care in England. N Engl J Med 2009; 361 (04) 368-378
    CrossrefPubMedGoogle Scholar
  • 15 Morgan OW, Griffiths C, Majeed A. Interrupted time-series analysis of regulations to reduce paracetamol (acetaminophen) poisoning. PLoS Med 2007; 4 (04) e105
    CrossrefPubMedGoogle Scholar
  • 16 Wagner AK, Soumerai SB, Zhang F, Ross-Degnan D. Segmented regression analysis of interrupted time series studies in medication use research. J Clin Pharm Ther 2002; 27 (04) 299-309
    CrossrefPubMedGoogle Scholar
  • 17 Stevens V, Geiger K, Concannon C, Nelson RE, Brown J, Dumyati G. Inpatient costs, mortality and 30-day re-admission in patients with central-line-associated bloodstream infections. Clin Microbiol Infect 2014; 20 (05) O318-O324
    CrossrefPubMedGoogle Scholar
  • 18 Green WH. Econometric Analysis. 7th ed. Upper Saddle River, NJ: Prentice Hall; 2012
    Google Scholar
  • 19 Green WH. Econometric Analysis. 8th ed. New York: Pearson; 2018: 149
    Google Scholar
  • 20 CDC/NCHS National Hospital Discharge Survey. Hyatsville, MD: National Center for Healthcare Statistics; 2010. . Updated 2010. Available at: https://www.cdc.gov/nchs/data/nhds/4procedures/2010pro4_numberprocedureage.pdf . Accessed June 23, 2019
    Google Scholar
  • 21 Stephen AE, Berger DL. Shortened length of stay and hospital cost reduction with implementation of an accelerated clinical care pathway after elective colon resection. Surgery 2003; 133 (03) 277-282
    CrossrefPubMedGoogle Scholar
  • 22 Dong W, Huang Z. A method to evaluate critical factors for successful implementation of clinical pathways. Appl Clin Inform 2015; 6 (04) 650-668
    Article in Thieme ConnectPubMedGoogle Scholar
  • 23 Neame MT, Chacko J, Surace AE, Sinha IP, Hawcutt DB. A systematic review of the effects of implementing clinical pathways supported by health information technologies. J Am Med Inform Assoc 2019; 26 (04) 356-363
    CrossrefPubMedGoogle Scholar
  • 24 Fleming M, MacFarlane D, Torres WE, Duszak Jr R. Magnitude of impact, overall and on subspecialties, of transitioning in radiology from ICD-9 to ICD-10 Codes. J Am Coll Radiol 2015; 12 (11) 1155-1161
    CrossrefPubMedGoogle Scholar