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Outcome-Based Medicine?

Outcome-Based Medicine?. Ron Collins, MD FRCP(C) Medical Director, Enhanced Recovery Interior Health Anesthesiologist, KGH. Enhanced Recovery After Surgery.

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Outcome-Based Medicine?

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  1. Outcome-Based Medicine? Ron Collins, MD FRCP(C) Medical Director, Enhanced Recovery Interior Health Anesthesiologist, KGH

  2. Enhanced Recovery After Surgery “The profession has placed high value on developing the basic science of medicine: it has not emphasized the process by which the science is translated into practice…” Eddy, DM. N Engl J Med 1982;307:343-7 “The immediate challenge to improving the quality of surgical care is not discovering new knowledge, but rather how to integrate what we already know into practice.” Urbach DR, Baxter NN, BMJ 2005

  3. Relative Contributions to Adverse Events and Excess Length of Stayadapted from Fry et al, J Am CollSurg2008;207:698-704

  4. Evidence! Quality Initiative

  5. “Ultimately, improving quality will require efforts that go beyond outcomes assessment alone. Future work should aim to improve our current understanding of processes of care associated with superior surgical outcomes.”Fry et al., J. Am CollSurg 2008;207:698-704

  6. Enhanced Recovery After Colorectal Surgery • Evidence-Based Surgical Care and the Evolution of Fast-Track Surgery • Kehlet, H. and Wilmore, D.; Ann Surg 2008;248:189-98 • Consensus Review of Optimal Peri-operative Care in Colorectal Surgery • ERAS Group; Arch Surg. 2009;144(10):961-969

  7. Length of stay reduced from 12.8 to 4.0 days. RIW reduced from 3.41 to 1.76 Benefit/cost ratio: 2.18 ROI: 118% CIHI estimated cost reduction of 48.4%.

  8. Implementing new routinesAreweusing”Best practice”? The German ”Prevalence”Study in ICU 92% M M Levy, ASPEN 2007

  9. It is not like we think it is…. The German ”Prevalence”Study 92% 4% M M Levy, ASPEN 2007

  10. Interior Health Authority IH Overall Intra-operative Fluid Management Our Vision: To set new standards of excellence in the delivery of health services in the Province of British Columbia

  11. Interior Health Authority IH Overall Length Of Stay Our Vision: To set new standards of excellence in the delivery of health services in the Province of British Columbia

  12. What is the role of GDT?

  13. Outcome Measurement…. Is perception matched by reality? Is the anticipated benefit happening? Are there unanticipated benefits? Are there unanticipated harms emerging? Are objective benefits matched by subjective benefits?

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