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Tytuł pozycji:

Return on investment of the Enhanced Recovery After Surgery (ERAS) multiguideline, multisite implementation in Alberta, Canada.

Tytuł:
Return on investment of the Enhanced Recovery After Surgery (ERAS) multiguideline, multisite implementation in Alberta, Canada.
Autorzy:
Thanh N; From the Strategic Clinical Networks, Alberta Health Services, Edmonton and Calgary, Alta. (Thanh, Wasylak); the Surgery Strategic Clinical Network, Alberta Health Services, Calgary, Alta. (A. Nelson); Analytics, Data Integration, Measurement and Reporting, Alberta Health Services, Edmonton and Calgary, Alta. (Wang, Faris); the Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alta. (Gramlich); and the Section of Gynecologic Oncology, Tom Baker Cancer Centre, University of Calgary, Calgary, Alta. (G. Nelson).
Nelson A; From the Strategic Clinical Networks, Alberta Health Services, Edmonton and Calgary, Alta. (Thanh, Wasylak); the Surgery Strategic Clinical Network, Alberta Health Services, Calgary, Alta. (A. Nelson); Analytics, Data Integration, Measurement and Reporting, Alberta Health Services, Edmonton and Calgary, Alta. (Wang, Faris); the Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alta. (Gramlich); and the Section of Gynecologic Oncology, Tom Baker Cancer Centre, University of Calgary, Calgary, Alta. (G. Nelson).
Wang X; From the Strategic Clinical Networks, Alberta Health Services, Edmonton and Calgary, Alta. (Thanh, Wasylak); the Surgery Strategic Clinical Network, Alberta Health Services, Calgary, Alta. (A. Nelson); Analytics, Data Integration, Measurement and Reporting, Alberta Health Services, Edmonton and Calgary, Alta. (Wang, Faris); the Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alta. (Gramlich); and the Section of Gynecologic Oncology, Tom Baker Cancer Centre, University of Calgary, Calgary, Alta. (G. Nelson).
Faris P; From the Strategic Clinical Networks, Alberta Health Services, Edmonton and Calgary, Alta. (Thanh, Wasylak); the Surgery Strategic Clinical Network, Alberta Health Services, Calgary, Alta. (A. Nelson); Analytics, Data Integration, Measurement and Reporting, Alberta Health Services, Edmonton and Calgary, Alta. (Wang, Faris); the Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alta. (Gramlich); and the Section of Gynecologic Oncology, Tom Baker Cancer Centre, University of Calgary, Calgary, Alta. (G. Nelson).
Wasylak T; From the Strategic Clinical Networks, Alberta Health Services, Edmonton and Calgary, Alta. (Thanh, Wasylak); the Surgery Strategic Clinical Network, Alberta Health Services, Calgary, Alta. (A. Nelson); Analytics, Data Integration, Measurement and Reporting, Alberta Health Services, Edmonton and Calgary, Alta. (Wang, Faris); the Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alta. (Gramlich); and the Section of Gynecologic Oncology, Tom Baker Cancer Centre, University of Calgary, Calgary, Alta. (G. Nelson).
Gramlich L; From the Strategic Clinical Networks, Alberta Health Services, Edmonton and Calgary, Alta. (Thanh, Wasylak); the Surgery Strategic Clinical Network, Alberta Health Services, Calgary, Alta. (A. Nelson); Analytics, Data Integration, Measurement and Reporting, Alberta Health Services, Edmonton and Calgary, Alta. (Wang, Faris); the Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alta. (Gramlich); and the Section of Gynecologic Oncology, Tom Baker Cancer Centre, University of Calgary, Calgary, Alta. (G. Nelson).
Nelson G; From the Strategic Clinical Networks, Alberta Health Services, Edmonton and Calgary, Alta. (Thanh, Wasylak); the Surgery Strategic Clinical Network, Alberta Health Services, Calgary, Alta. (A. Nelson); Analytics, Data Integration, Measurement and Reporting, Alberta Health Services, Edmonton and Calgary, Alta. (Wang, Faris); the Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alta. (Gramlich); and the Section of Gynecologic Oncology, Tom Baker Cancer Centre, University of Calgary, Calgary, Alta. (G. Nelson).
Źródło:
Canadian journal of surgery. Journal canadien de chirurgie [Can J Surg] 2020 Nov 30; Vol. 63 (6), pp. E542-E550. Date of Electronic Publication: 2020 Nov 30.
Typ publikacji:
Journal Article; Multicenter Study
Język:
English
Imprint Name(s):
Publication: Ottawa : Canadian Medical Association
Original Publication: Toronto, Canadian Medical Assn.
MeSH Terms:
Cost Savings/*statistics & numerical data
Enhanced Recovery After Surgery/*standards
Health Plan Implementation/*economics
Surgical Procedures, Operative/*rehabilitation
Aged ; Alberta/epidemiology ; Cost Savings/economics ; Female ; Humans ; Length of Stay/economics ; Length of Stay/statistics & numerical data ; Male ; Middle Aged ; Patient Acceptance of Health Care/statistics & numerical data ; Patient Readmission/economics ; Patient Readmission/statistics & numerical data ; Postoperative Complications/economics ; Postoperative Complications/epidemiology ; Postoperative Complications/etiology ; Postoperative Complications/prevention & control ; Practice Guidelines as Topic ; Surgical Procedures, Operative/adverse effects
References:
Can J Surg. ;59(6):415-421. (PMID: 28445024)
Gynecol Oncol. 2018 Oct;151(1):117-123. (PMID: 30100053)
J Pediatr. 2015 Sep;167(3):551-6.e1-3. (PMID: 26148659)
Can J Anaesth. 2015 Feb;62(2):219-30. (PMID: 25391739)
JAMA Surg. 2017 Mar 1;152(3):292-298. (PMID: 28097305)
Clin Nutr. 2010 Aug;29(4):434-40. (PMID: 20116145)
J Surg Oncol. 2017 Oct;116(5):608-612. (PMID: 28873501)
Implement Sci. 2017 May 19;12(1):67. (PMID: 28526041)
Am J Epidemiol. 2011 Mar 15;173(6):676-82. (PMID: 21330339)
Ann Surg. 2015 Dec;262(6):1026-33. (PMID: 25371130)
Pharmacoeconomics. 2013 May;31(5):361-7. (PMID: 23529207)
World J Surg. 2014 Jun;38(6):1531-41. (PMID: 24368573)
Contributed Indexing:
Local Abstract: [Publisher, French] L’initiative de récupération améliorée après la chirurgie (RAAC) est un projet international d’amélioration de la qualité en chirurgie. On en sait peu sur les retombées économiques, tant à court qu’à long terme, de la mise en œuvre de multiples lignes directrices de RAAC. [Publisher, French] Nous avons réalisé une analyse du rendement sur l’investissement (RSI) visant la mise en œuvre de multiples lignes directrices de RAAC (pour les opérations colorectales, pancréatiques, hépatiques ou d’oncologie gynécologique et la cystectomie) dans 9 hôpitaux albertains sur un horizon temporel de 30, 180 et 365 jours. L’incidence de la RAAC sur l’utilisation des services de santé (durée du séjour à l’hospitalisation initiale, nombre de réadmissions, durée du séjour à la réhospitalisation et nombre de visites à l’urgence, en consultation externe, chez un spécialiste et chez un omnipraticien) a été évaluée à l’aide d’un modèle multiniveau de régressions binomiales négatives à effets mixtes multivariés. Les bénéfices nets et le RSI ont été estimés à l’aide d’un processus de modélisation analytique décisionnelle. Tous les coûts ont été rapportés en dollars canadiens de 2019. [Publisher, French] Les économies nettes du système de santé allaient de 26,35 $ à 3606,44 $ par patient, et le RSI variait de 1,05 à 7,31; chaque dollar investi dans l’initiative de RAAC a donc généré un retour sur l’investissement de 1,05 $ à 7,31 $. Les probabilités d’économie grâce au RAAC allaient de 86,5% à 99,9%. Les retombées générées augmentaient avec un horizon temporel à plus long terme, ce qui suggère que l’utilisation unique d’un horizon temporel de 30 jours aurait mené à une sousestimation des bénéfices. [Publisher, French] Les résultats montrent que la mise en œuvre de multiples lignes directrices de RAAC a permis des économies en Alberta. En vue d’obtenir un RSI optimal, il est important de tenir compte d’une grande variété d’utilisations des services de santé, des retombées à long terme, des économies d’échelle, de l’efficacité productive et de l’efficience des allocations pour la pérennité, la mise à l’échelle et la diffusion des projets de mise en œuvre de RAAC.
Entry Date(s):
Date Created: 20201130 Date Completed: 20210218 Latest Revision: 20210218
Update Code:
20240105
PubMed Central ID:
PMC7747851
DOI:
10.1503/cjs.006720
PMID:
33253512
Czasopismo naukowe
Background: Enhanced Recovery After Surgery (ERAS) is a global surgical qualityimprovement initiative. Little is known about the economic effects of implementing multiple ERAS guidelines in both the short and long term.
Methods: We performed a return on investment (ROI) analysis of the implementation of multiple ERAS guidelines (for colorectal, pancreas, cystectomy, liver and gynecologic oncology procedures) across multiple sites (9 hospitals) in Alberta using 30-, 180- and 365-day time horizons. The effects of ERAS on health services utilization (length of stay of the primary admission, number of readmissions, length of stay of the readmissions, number of emergency department visits, number of outpatient clinic visits, number of specialist visits and number of general practitioner visits) were assessed by mixed-effect multilevel multivariate negative binomial regressions. Net benefits and ROI were estimated by a decision analytic modelling analysis. All costs were reported in 2019 Canadian dollars.
Results: The net health system savings per patient ranged from $26.35 to $3606.44 and ROI ranged from 1.05 to 7.31, meaning that every dollar invested in ERAS brought $1.05 to $7.31 in return. Probabilities for ERAS to be cost-saving were from 86.5% to 99.9%. The effects of ERAS were found to be larger in the longer time horizons, indicating that if only the 30-day time horizon had been used, the benefits of ERAS would have been underestimated.
Conclusion: These results demonstrated that ERAS multiguideline implementation was cost-saving in Alberta. To produce a better ROI, it is important to consider a broad range of health service utilizations, long-term impact, economies of scale, productive efficiency and allocative efficiency for sustainability, scale and spread of ERAS implementations.
Competing Interests: G. Nelson is secretary of the ERAS Society. No other competing interests were declared.
(© 2020 Joule Inc. or its licensors.)

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