Systems innovation model: an integrated interdisciplinary team approach pre- and post-bariatric surgery at a veterans affairs (VA) medical center
| Autor: | Eric Kubat, Lauren M. Greenberg, Susan M. Frayne, Jessica A. Lohnberg, Cheryl Bates, Dan Eisenberg |
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| Rok vydání: | 2017 |
| Předmět: |
Male
Program evaluation medicine.medical_specialty Hospitals Veterans Interprofessional Relations Population Specialty Bariatric Surgery 030209 endocrinology & metabolism Body Mass Index 03 medical and health sciences 0302 clinical medicine Quality of life Weight management medicine Humans 030212 general & internal medicine education Veterans Affairs Retrospective Studies Veterans education.field_of_study business.industry Quality Improvement Mental health United States Obesity Morbid Surgery United States Department of Veterans Affairs Quality of Life Physical therapy Female business Body mass index Program Evaluation |
| Zdroj: | Surgery for Obesity and Related Diseases. 13:600-606 |
| ISSN: | 1550-7289 |
| Popis: | Background Provision of bariatric surgery in the Veterans Health Administration must account for obese veterans' co-morbidity burden and the geographically dispersed location of patients relative to Veterans Affairs (VA) bariatric centers. Objectives To evaluate a collaborative, integrated, interdisciplinary bariatric team of surgeons, bariatricians, psychologists, dieticians, and physical therapists working in a hub-and-spokes care model, for pre- and post-bariatric surgery assessment and management. Methods This is a description of an interdisciplinary clinic and bariatric program at a VA healthcare system and a report on program evaluation findings. Retrospective data of a prospective database was abstracted. For program evaluation, we abstracted charts to characterize patient data and conducted a patient survey. Results Since 2009, 181 veterans have undergone bariatric surgery. Referrals came from 7 western U.S. states. Mean preoperative body mass index was 46 kg/m 2 (maximum 71). Mean age was 53 years, with 33% aged>60 years; 79% were male. Medical co-morbidity included diabetes (70%), hypertension (85%), and lower back or extremity joint pain (84%). A psychiatric diagnosis was present in 58%. At 12 months, follow-up was 81% and percent excess body mass index loss was 50.5%. Among 54 sequential clinic patients completing anonymous surveys, overall satisfaction with the interdisciplinary team approach and improved quality of life were high (98% and 94%, respectively). Conclusion The integrated, interdisciplinary team approach using a hub-and-spokes model is well suited to the VA bariatric surgery population, with its heavy burden of medical and mental health co-morbidity and its system of geographically dispersed patients receiving treatment at specialty centers. As the VA seeks to expand the use of bariatric surgery as an option for obese veterans, interdisciplinary models crafted to address case complexity, care coordination, and long-term outcomes should be part of policy planning efforts. |
| Databáze: | OpenAIRE |
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