MEETING THE CHALLENGE OF MANAGED CARE THROUGH CLINICAL PATHWAYS FOR BARIATRIC SURGERY

Background: The 1990s will bring sweeping changes in managed care and capitation. Health care providers are continually searching for new wa ys to improve the quality of patient-care outcomes in the obese. Impro ving clinical care by promoting the use of processes that have been pr oved to yield optimal outcomes has become a powerful strategy for meas uring the value of services provided. Methods: To address this cost/qu ality paradox, an optimal care path (OCP) was developed as a guideline for all patients undergoing gastric bypass or laparoscopic adjustable gastric banding. A transdisciplinary team developed the OCP, preprint ed orders, discharge home instruction sheet, and daily guidelines for patients. Ail patients were provided with OCPs from July 1995 to Septe mber 1997. Results: Length of stay decreased from 6.5 days to 5.4 days (16.9%); the average total charges decreased 17.6%, or $2,683; the pe rcentage of wound infections decreased; and communication between, and collaboration of, interdisciplinary team members increased across the continuum of care. Conclusions: The study suggests that the use of OC P does not impair quality of care and can produce significant cost sav ings to a health care facility.