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

Publication ,  Journal Article
Shah, R; Diaz, A; Tripepi, M; Bagante, F; Tsilimigras, DI; Machairas, N; Sigala, F; Moris, D; Barreto, SG; Pawlik, TM
Published in: Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract
December 2020

There has been a dramatic increase in worldwide health care spending over the last several decades. Operative procedures and perioperative care in the USA represent some of the most expensive episodes per patient. In view of both the rising cost of health care in general and the rising cost of surgical care specifically, policymakers and stakeholders have sought to identify ways to increase the value-improving quality of care while controlling (or diminishing) costs. In this context, we reviewed data relative to achieving the "value proposition" in the delivery of gastrointestinal surgical care.The National Library of Medicine online repository (PubMed) was text searched for human studies including "cost," "quality," "outcomes," "health care," "surgery," and "value." Results from this literature framed by the Donabedian conceptual model (identifying structures, processes, and outcomes), and the resulting impact of efforts to improve quality on costs.The relationship between quality and costs was nuanced. Better quality care, though associated with better outcomes, was not always reported as concomitant with low costs. Moreover, some centers reported higher costs of surgical care commensurate with higher quality. Conversely, higher costs in health care delivery were not always linked to improved outcomes. While higher quality surgical care can lead to lower costs, higher costs of care were not necessarily associated with better outcomes. Strategies to improve quality, reduce cost, or achieve both simultaneously included regionalization of complex operations to high-volume centers of excellence, overall reduction in complications, introducing evidence-based improvements in perioperative care pathways including as enhanced recovery after surgery (ERAS), and elimination of inefficient or low-value care.The relationship between quality and cost following gastrointestinal surgical procedure is complex. Data from the current study should serve to highlight the various means available to improve the value proposition related to surgery, as well as encourage surgeons to become more engaged in the national conversation around the Triple Aim of better health care quality, lower costs, and improved health care outcomes.

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Published In

Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract

DOI

EISSN

1873-4626

ISSN

1091-255X

Publication Date

December 2020

Volume

24

Issue

12

Start / End Page

2874 / 2883

Related Subject Headings

  • Surgery
  • Surgeons
  • Quality of Health Care
  • Perioperative Care
  • Humans
  • Digestive System Surgical Procedures
  • Delivery of Health Care
  • 3202 Clinical sciences
  • 1103 Clinical Sciences
 

Citation

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Chicago
ICMJE
MLA
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Shah, R., Diaz, A., Tripepi, M., Bagante, F., Tsilimigras, D. I., Machairas, N., … Pawlik, T. M. (2020). Quality Versus Costs Related to Gastrointestinal Surgery: Disentangling the Value Proposition. Journal of Gastrointestinal Surgery : Official Journal of the Society for Surgery of the Alimentary Tract, 24(12), 2874–2883. https://doi.org/10.1007/s11605-020-04748-7
Shah, Rohan, Adrian Diaz, Marzia Tripepi, Fabio Bagante, Diamantis I. Tsilimigras, Nikolaos Machairas, Fragiska Sigala, Dimitrios Moris, Savio George Barreto, and Timothy M. Pawlik. “Quality Versus Costs Related to Gastrointestinal Surgery: Disentangling the Value Proposition.Journal of Gastrointestinal Surgery : Official Journal of the Society for Surgery of the Alimentary Tract 24, no. 12 (December 2020): 2874–83. https://doi.org/10.1007/s11605-020-04748-7.
Shah R, Diaz A, Tripepi M, Bagante F, Tsilimigras DI, Machairas N, et al. Quality Versus Costs Related to Gastrointestinal Surgery: Disentangling the Value Proposition. Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract. 2020 Dec;24(12):2874–83.
Shah, Rohan, et al. “Quality Versus Costs Related to Gastrointestinal Surgery: Disentangling the Value Proposition.Journal of Gastrointestinal Surgery : Official Journal of the Society for Surgery of the Alimentary Tract, vol. 24, no. 12, Dec. 2020, pp. 2874–83. Epmc, doi:10.1007/s11605-020-04748-7.
Shah R, Diaz A, Tripepi M, Bagante F, Tsilimigras DI, Machairas N, Sigala F, Moris D, Barreto SG, Pawlik TM. Quality Versus Costs Related to Gastrointestinal Surgery: Disentangling the Value Proposition. Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract. 2020 Dec;24(12):2874–2883.
Journal cover image

Published In

Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract

DOI

EISSN

1873-4626

ISSN

1091-255X

Publication Date

December 2020

Volume

24

Issue

12

Start / End Page

2874 / 2883

Related Subject Headings

  • Surgery
  • Surgeons
  • Quality of Health Care
  • Perioperative Care
  • Humans
  • Digestive System Surgical Procedures
  • Delivery of Health Care
  • 3202 Clinical sciences
  • 1103 Clinical Sciences