A Standardized Framework for Evaluating Surgical Enhanced Recovery Pathways: A Recommendations Statement from the TDABC in Health-care Consortium

Abstract

Background: Innovative methodologies to redesign care delivery are being applied to increase value in health care, including the creation of enhanced recovery pathways (ERPs) for surgical patients. However, there is a lack of standardized methods to evaluate ERP implementation costs. Objectives: This Recommendations Statement aims to introduce a standardized framework to guide the economic evaluation of ERP care-design initiatives, using the Time-Driven Activity-Based Costing (TDABC) methodology. Methods: We provide recommendations on using the proposed framework to support the decision-making processes that incorporate ERPs. Since ERPs are usually composed of activities distributed throughout the patient care pathway, the framework can demonstrate how the TDABC may be a valuable method to evaluate the incremental costs of protocol implementation. Our recommendations are based on the review of available literature and expert opinions of the members of the TDABC in Healthcare Consortium. Results: The ERP framework, composed of 11 steps, was created describing how the techniques and methods can be applied to evaluate the economic impact of an ERP and guide health-care leaders to optimize the decision-making process of incorporating ERPs into health-care settings. Finally, six recommendations are introduced to demonstrate that using the suggested framework could increase value in ERP care-design initiatives by reducing variability in care delivery, educating multidisciplinary teams about value in health, and increasing transparency when managing surgical pathways. Conclusions: Our proposed standardized framework can guide decisions and support measuring improvements in value achieved by incorporating the perioperative redesign protocols.

Time‐Driven Activity‐Based Cost Comparison of Thyroid Lobectomy and Radiofrequency Ablation

“…With medical debt remaining the leading cause of bankruptcy in the United States, patients have a greater interest in managing what costs will be passed onto them 3 . Implementation of TDABC can permit hospitals to more accurately project costs and profits, understand how specific business decisions can affect the organization's balance sheet, standardize costs and charges, and determine where cost efficiency is lacking in the care cycle 11 . In its most conventional form, Value = Quality/Cost 15 .…”

“…3 Implementation of TDABC can permit hospitals to more accurately project costs and profits, understand how specific business decisions can affect the organization's balance sheet, standardize costs and charges, and determine where cost efficiency is lacking in the care cycle. 11 In its most conventional form, Value = Quality/ Cost. 15 This study analyzed cost, but not quality.…”

Hip and Knee Arthroplasty

“…Most studies evaluating pathway efficacy are restricted to traditional outcomes, such as LOS, readmission, mortality, and complications, and may not be sufficiently sensitive to detect benefits of individual clinical interventions, like peripheral nerve blocks, which would not be expected to influence mid-to-long-term outcomes. 45 More recently, studies have considered patient-reported outcome measures and system-wide cost savings as indices of pathway efficacy. 46 These have increased the complexity of effectiveness analyses, but also the relevance of study findings, and are required for comparative evaluation of published studies.…”

“…A complete review of methods to standardize outcomes assessment is out with the scope of the current manuscript, but calls have been made to derive a core set of outcomes and measurements for enhanced recovery programs. In addition to process evaluation, these should ideally reflect the different perspectives of key stakeholders (patients and practitioners) as well as the stage of recovery, and assessment of procedure-specific clinical improvement [45][46] In the case of TJA, it should also be acknowledged that although patient-reported outcome measures (PROMs) show improvement in most patients, discrepancies are seen when compared with measures of physical performance, both in the early and later recovery phase. [47][48]…”

The role of disruptive technologies and approaches in ERAS®: erupting change through disruptive means

“…Lean principles Identification and elimination of unnecessary resource utilization in ERAS® pathways to decrease time, resources, and cost Collar et al (2012) [ 21 ] 20. Time-driven activity-based costing (TDABC) pathways Identification of cost drivers to accurately assess ERAS® finances and identify processes to target for quality improvement Allin et al (2021) [ 22 ] …”