VBHC in a high volume bariatric center in Italy
Morbid obesity is an increasingly prevalent condition worldwide. It’s associated with long term comorbidities (ie: diabetes, cardiac and respiratory disease, cancer), reduced survival (higher any cause-any age mortality), mental illness (ie: depression, anxiety) and poorer health related quality of life. Morbid obesity has become a serious international public health concern with a considerable impact on direct and indirect costs, including productivity. It’s a chronic disease caused and maintained by a complex interplay of medical-somatic, psychological and social factors.
Bariatric surgery is actually the most effective treatment for morbid obesity, resulting in sustained weight loss as well as pronounced effects on obesity-related comorbidities. Care of these patients means much more than technical skills: an evidence based clinical approach should be integrated with a structured psychological and educational support and many resources and assets should be considered especially if they are candidate to surgery. Humanitas is a high efficient hospital in Italy used to manage high volumes per year. The challenge we enter into was to combine high volume (> 1000 patients/year) and value for bariatric patients.
A multiprofessional team, organized as an integrated practice unit (IPU) where patients and carers are part of the team, redesigned the complete cycle of care starting from international benchmark, Enhanced Recovery After Surgery approach (ERAS) and patients’ needs. Measuring the evolution of quality indicators, including patients’ perspectives, has shown how quality and efficiency are deeply intertwined. Delivering superior value consisted in better health outcomes with results that overcome European benchmarks (zero mortality; near zero morbidity and readmissions; sustained weight loss; full recovery form comorbidities), satisfying PROMs (return to work, dress, physical and sexual activity) maintaining efficiency at the same hospital costs and with priceless healthcare and social impact.
The result of our initiative is that 2500 morbidly obese patients, that usually have the highest costs in healthcare and higher any cause mortality at any age, have already gained the chance of a new life.
This is just the beginning: the value based Humanitas Bariatric Model, standardized but shaped on patients’ needs, has become the prototype for all the other clinical processes of our hospital and could be delivered to many patients who are waiting for care, in terms of clinical excellence and better life too.