Evaluation of Hysterectomy Pathways: Opportunities to Improve Health Care Delivery

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 over-utilization, 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 was 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 was to generate information that can be used to provide recommendations for improving costs while improving patient outcomes.

Improvements

All noncancerous hysterectomy surgeries performed at UPMC hospitals between the pre-pathway implementation period (2008-2011) and the post-pathway implementation period (2012-2014) were analyzed by surgical approach (open versus minimally invasive). Outcomes evaluated included 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.

Outcomes

This project showed that implementation of Hysterectomy Pathways has led to a reduction in complications (hospital readmission and infection) and greatly increased the value of care.

Information gathered from this analysis and evaluation resulted in four published papers and an abstract, that appeared in The Green Journal, the prestigious official publication of the American College of Obstetrics & Gynecology, Women’s Health Issues, and Journal of Racial and Ethnic Health Disparities. The project also was presented in an opening session of the ACOG conference. Ideas generated from the project will be used in the development of future support tools.