• Ana Paula Etges

Advances in evaluation methods to support the decision making process of surgical pathways redesign

Atualizado: 20 de ago. de 2021

Principal researchers: Ana Paula Beck da Silva Etges and Richard D. Urman


The redesign of surgical pathways has been used as a compelling manner to contribute to greater assurance of quality when providing a patient-centered service. The Enhanced Recovery After Surgery (ERAS) society has published a list of recent recommendation guidelines orienting good practices that may be adopted by hospitals to increase the quality of care. Regarding the evaluation of the impact that an internal redesign may achieve, the literature usually reports clinical outcomes results. However, the decision making to invest in an internal culture change may consider multiples variables, including the economic impact. Usually, the recommendation guides include a list of process of care suggestions, such as: multi-professional consulting routines, patient and family education, exclusive diet analysis, exams that may be monitored (before and after), post-surgery care, use of telemedicine services, and others. Length of time of hospitalization after surgery, consumption of specific medications, pain, and rehospitalizations are frequently used as outcomes to evaluate the pathway impact. The health technology assessment research area is continually advancing in economic models to orient the right decisions in health-care. However, the evaluation of the implementation or changing of a new pathway is innovative and scarce from economic models’ recommendation to support the decision-making process. As a tendency in recent studies, the method Time-driven Activity-based Costing (TDABC) has been used as a powerful technique that can evaluate costs by the comprehension of the patient’s entire episode of care. In its principle, the method evaluates the processes of care by the identification of all activities that patients are submitted. Considering the patient cycle care change that happens in a pathway redesign project, we have studied how those advanced cost management methods could be applied to support the decision making process associated with the development of surgical pathways redesign projects. This project aims to develop a recommendation guide including economic, clinical, and patient reported outcomes to support health-care managers to decide about the adoption of surgical pathways redesign and innovative projects.

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