Quality Versus Costs Related to Gastrointestinal Surgery: Disentangling the Value Proposition

Shah, Rohan; Díaz, Adrián; Tripepi, Marzia; Bagante, Fabio; Tsilimigras, Diamantis I.; Machairas, Nikolaos; Sigala, Fragiska; Moris, Demetrios; Barreto, Savio George; Pawlik, Timothy M.

doi:10.1007/s11605-020-04748-7

Cited by 15 publications

(4 citation statements)

References 105 publications

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“…The SPO model is underpinned by a theoretical assumption that a good structure should promote a good process and a good process should promote good outcomes, which is conducive to guiding the effective improvement of medical quality 68. Therefore, the SPO model is valuable in organising medical quality evaluation and has been widely adopted in ERAS quality evaluation research 69 70. In this systematic review, the SPO model was used to analyse the issues of SPO that potentially affect patients’ implementation of ERAS programmes.…”

Section: Methodsmentioning

confidence: 99%

Issues in patients’ experiences of enhanced recovery after surgery (ERAS) : a systematic review of qualitative evidence

Wang

et al. 2023

BMJ Open

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ObjectiveTo explore patients’ experiences of enhanced recovery after surgery (ERAS) and to identify issues in the implementation of ERAS from the patient’s perspective.DesignThe systematic review and qualitative analysis were based on the Joanna Briggs Institute’s methodology for conducting synthesis.Data sourcesRelevant studies published in four databases, that is, Web of Science, PubMed, Ovid Embase and the Cochrane Library, were systematically searched, and some studies were supplemented by key authors and reference lists.Study selectionThirty-one studies were identified, involving 1069 surgical patients enrolled in the ERAS programme. The inclusion and exclusion criteria were formulated based on the Population, Interest of phenomena, Context, Study design criteria recommended by the Joanna Briggs Institute to determine the scope of article retrieval. The inclusion criteria were as follows: ERAS patients’ experiences; qualitative data; English language and published from January 1990 to August 2021.Data extractionData were extracted from relevant studies using the standardised data extraction tool from Joanna Briggs Institute Qualitative Assessment and Review Instrument for qualitative research.Data synthesisThe themes in the structure dimension are as follows: (1) patients cared about the timeliness of healthcare professionals’ help; (2) patients cared about the professionalism of family care; and (3) patients misunderstood and worried about the safety of ERAS. The themes in the process dimension are as follows: (1) patients needed adequate and accurate information from healthcare professionals; (2) patients needed to communicate adequately with healthcare professionals; (3) patients hoped to develop a personalised treatment plan and (4) patients required ongoing follow-up services. The theme in the outcome dimension is as follows: patients wanted to effectively improve severe postoperative symptoms.ConclusionsEvaluating ERAS from the patient’s perspective can reveal the omissions and deficiencies of healthcare professionals in clinical care so that problems in patients’ recovery process can be solved in a timely manner, reducing potential barriers to the implementation of ERAS.PROSPERO registration numberCRD42021278631.

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Section: Methodsmentioning

confidence: 99%

Issues in patients’ experiences of enhanced recovery after surgery (ERAS) : a systematic review of qualitative evidence

Wang

et al. 2023

BMJ Open

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“… 29 Therefore, the approach of Donabedian is valuable in conceptualising and organising medical quality evaluation, 30 and has been widely adopted in the research of ERAS quality evaluation. 31 In this qualitative interview study, the SPO model was used to analyse the barriers of SPO that potentially affect the implementation of ERAS programmes. The ‘structure’ refers to the methods of resource allocation and the efficiency of resource utilisation in medical services, such as the adequacy of facilities and equipment, sufficient staff and financial resources, and complete management policies.…”

Section: Methodsmentioning

confidence: 99%

“…The SPO model also has theoretical underpinnings in that good structure should promote good process and good process should promote good outcomes, which is conducive to guiding the effective improvement of medical quality 29. Therefore, the approach of Donabedian is valuable in conceptualising and organising medical quality evaluation,30 and has been widely adopted in the research of ERAS quality evaluation 31. In this qualitative interview study, the SPO model was used to analyse the barriers of SPO that potentially affect the implementation of ERAS programmes.…”

Section: Methodsmentioning

confidence: 99%

Barriers to implementation of enhanced recovery after surgery (ERAS) by a multidisciplinary team in China: a multicentre qualitative study

et al. 2022

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ObjectiveTo explore the attitudes and barriers encountered in the implementation of enhanced recovery after surgery (ERAS) in China from the perspective of multidisciplinary team members.DesignBased on Donabedian’s structure–process–outcome (SPO) model, a multicentre qualitative study using semistructured interviews was conducted.SettingFrom September 2020 to December 2020, the participants of this study were interviewed from six tertiary hospitals in Sichuan province (n=3), Jiangsu province (n=2) and Guangxi province (n=1) in China.ParticipantsA total of 42 members, including surgeons (n=11), anaesthesiologists (n=10), surgical nurses (n=14) and dietitians(n=7) were interviewed.ResultsMultidisciplinary team (MDT) members still face many barriers during the process of implementing ERAS. Eight main themes are described around the barriers in the implementation of ERAS. Themes in the structure dimension are: (1) shortage of medical resources, (2) lack of policy support and (3) outdated concepts. Themes in the process dimension are: (1) poor doctor–patient collaboration, (2) poor communication and collaboration among MDT members and (3) lack of individualised management. Themes in the outcome dimension are: (1) low compliance and (2) high medical costs. The current implementation of ERAS is still based on ideas more than reality.ConclusionsIn general, barriers to ERAS implementation are broad. Identifying key elements of problems in the application and promotion of ERAS from the perspective of the MDT would provide a starting point for future quality improvement of ERAS, enhance the clinical effect of ERAS and increase formalised ERAS utilisation in China.

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“…As everyone understands that APN advances towards the reorganization of services in which the patient is central, it assumes the management of the population's health as a unique protagonist, able to contribute to the sustainability of health systems. However, in countries with free and universal health systems, such as the United Kingdom, Brazil and others, the implementation of these new health technologies requires evidence on the economic impact, not only as a subsidy for the formulation of health policies, but especially as a strategy to identify health technologies that add value to care, facts that strengthen the need to use cost-effective techniques (16,17) .…”

Section: Rationale For Apn Implementationmentioning

confidence: 99%

Cost-effectiveness analysis of the implementation of advanced practice nursing: how to move forward?

Sichieri

Secoli

2022

Rev. esc. enferm. USP

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This essay explores possibilities of advances in cost-effectiveness analysis (CEA) in advanced practice nursing (APN). The arguments were structured according to the current health landscape, the need to evaluate APN practices as health technology and evidence and recommendations for conducting CEA. Benefits of APN were evidenced in the improvement of indicators such as mortality, hospital readmission, among others. However, the absence of a standard of care, combined with the existence of different models and short time horizon interfered with the estimation of direct costs. The studies on CEA were inconclusive, mainly due to the lack of cost per unit of success and calculation of the CEA ratio. In the context of the APN, to conduct CEA that really contributes to robust results, thus subsidizing decision-making requires a joint effort of training institutions, delimitation and standardization of practice by regulatory agencies of the profession and health services, based especially on accreditation policies.

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Quality Versus Costs Related to Gastrointestinal Surgery: Disentangling the Value Proposition

Cited by 15 publications

References 105 publications

Issues in patients’ experiences of enhanced recovery after surgery (ERAS) : a systematic review of qualitative evidence

Issues in patients’ experiences of enhanced recovery after surgery (ERAS) : a systematic review of qualitative evidence

Barriers to implementation of enhanced recovery after surgery (ERAS) by a multidisciplinary team in China: a multicentre qualitative study

Cost-effectiveness analysis of the implementation of advanced practice nursing: how to move forward?

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