???Through this evaluation of the Hysterectomy Pathways, we are providing payers, providers, and consumers with essential data regarding clinical outcomes, complication rates, recovery rates, patient satisfaction, and cost. It has the potential to significantly improve quality, value, and satisfaction with patient care.??? - Faina Linkov, PhD, MPH, University of Pittsburgh


Grant Application

Faina Linkov, PhD, MPH, University of Pittsburgh, and John Comerci, MD, Magee-Womens Hospital of UPMC


Proposed Innovation

Each year, approximately 600,000 women undergo a hysterectomy — one of the most common gynecologic procedures performed in the United States. Despite the benefits of such minimally invasive procedures as vaginal or laparoscopic hysterectomy, the majority of hysterectomies outside of major academic centers are performed through open (abdominal) surgery. In an effort to reduce this overutilization, a clinical pathway treatment algorithm was implemented within the UPMC system in 2012 to encourage gynecologic surgeons to reduce the use of open hysterectomy for benign conditions as a way of reducing costs and improving outcomes, including lower infection rates.

The goal of this project is to formally evaluate the success of the Hysterectomy Pathways algorithm by examining medical and surgical perioperative complications, surgical site infections, 30-day readmissions, costs, and length of stay from pre- to post-pathway implementation. The overarching aim of this project is to use the information to provide recommendations for improved patient care and reduced cost.


Improvements in Action

All noncancerous hysterectomy surgeries performed at UPMC hospitals between the pre-pathway implementation period (2008-2011) and the post-pathway implementation period (2012-2014) will be analyzed by surgical approach (open versus minimally invasive). Outcomes to be evaluated include infection rates, length of stay, 30-day readmission rates, medical complications (deep vein thrombosis, pulmonary embolism), cost of care reduction, and transfusion rates. Physicians also will be surveyed to evaluate satisfaction with the pathway system and its integration with the electronic health record system.


Results – In Progress

Information gathered from the analysis and evaluation will be published and disseminated to providers within and outside the UPMC system. Ideas generated from the project will be used in the development of future decision support tools. As of July 1, 2015, two research papers have been developed on the use of pathways, where significant increases in the number of minimally invasive procedures have been demonstrated since 2012.