AN OUTCOMES MANAGEMENT PROGRAM IN GYNECOLOGIC ONCOLOGY

Objective: To evaluate the effectiveness of an outcomes-management pro gram designed to provide high-quality patient care, generate data for outcomes research, and decrease costs in a managed-care environment. M ethods: An outcomes-management program was launched in June 1994, base d on the elimination of wasteful or ineffective therapies through the systematic development of practice guidelines and collaborative care p aths, with concomitant definition of desired outcomes. Over 3 months, care paths were developed for our most common surgical procedures. A m atched control outcomes study was undertaken for the most commonly per formed gynecologic oncology procedure: total abdominal hysterectomy an d oophorectomy with pelvic and para-aortic node sampling for endometri al cancer. Thirty consecutive women treated on the care path were comp ared with 29 matched controls accrued during the period of care-path p lanning and with 73 controls from the period preceding care-path plann ing. Patient satisfaction with care-path treatment was assessed by a s urvey sent 2 weeks after discharge. Results: Median length of hospital stay decreased significantly, from 6 days before care-path planning t o 4 days after care-path implementation (P < .001). Median laboratory costs decreased by 74% (P < .001), medication costs by 35% (P < .001), room costs by 29% (P < .001), and total hospital costs by 20% (P < .0 02). 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 ve ry high among care-path patients. Conclusions: A physician-driven outc omes-management program in an academic setting permits the delivery of high-quality care and supports outcomes research while decreasing cos ts. (C) 1997 by The American College of Obstetricians and Gynecologist s.