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Hysterectomy Pathways: Systemic long-term impact on the reduction of open hysterectomy rates

Godiwala, Ayesha P. (2020) Hysterectomy Pathways: Systemic long-term impact on the reduction of open hysterectomy rates. Master Essay, University of Pittsburgh.

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Clinical pathways are defined as evidence-based, multidisciplinary care algorithms that outline essential steps in the management of patients. The objective of this work is to observe the impact of hysterectomy pathways on the reduction of open hysterectomy rates and improved patient outcomes. In 2012, the UPMC Health System introduced an evidence-based pathway treatment algorithm for hysterectomy with an overarching goal of reducing variations in surgical care and abdominal hysterectomy rates, thereby promoting cost containment and decreased patient morbidity. My work on this project involved generating a follow up report to the 2016 publication that analyzed the results from 2012 to 2014. I collaborated with colleagues at UPMC Magee Women’s Hospital to evaluate the rates of open hysterectomy procedures and complications to determine their long-term effects on patient outcomes.

UPMC Health System output from 2012 to 2019 was retrospectively identified for hysterectomy surgeries performed for benign indications. Health care outcomes by route of surgery and year were analyzed and tests for significance were administered to determine success of the implementation program by year.

From the beginning of 2012 to the end of the follow-up period in 2019, the implementation of the hysterectomy clinical pathway protocol demonstrated an absolute decrease of 22.3% of patients undergoing total abdominal hysterectomy (TAH) across the UPMC system. There was a statistically significant decrease in TAH in the follow-up period, from 17.1% at the end of 2014 to 5.5% at the end of 2019, despite the fact that active development and dissemination of the pathway program ended in 2014. The program continued to be successful past 2014 due to successful physician adoption and integration into the clinical workflow without significant additional education or other activities.

Our latest evidence regarding pathway utilization, consistent with initial studies, demonstrated that the proportion of TAH continued to decrease upon implementation of the pathway. Since hysterectomy clinical pathways are effective instruments in decreasing the rates of open hysterectomies, thus reducing complications and undesired practice variability while providing consistent care, the public health relevance of this work lies in the applicability of similar initiatives across gynecologic practices as well as different disciplines.


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Item Type: Other Thesis, Dissertation, or Long Paper (Master Essay)
Status: Unpublished
CreatorsEmailPitt UsernameORCID
Godiwala, Ayesha P.ayg7@pitt.eduayg70000-0001-8892-2824
ContributionContributors NameEmailPitt UsernameORCID
Committee ChairHaggerty, CatherineHaggertyC@edc.pitt.eduhaggertycUNSPECIFIED
Committee MemberMansuria, Suketumanssm@UPMC.EDUmansuriaUNSPECIFIED
Committee MemberLinkov, Fainalinkovf@duq.edufyl1UNSPECIFIED
Centers: Other Centers, Institutes, Offices, or Units > Magee-Women's Research Institute
Date: 11 December 2020
Date Type: Submission
Number of Pages: 30
Institution: University of Pittsburgh
Schools and Programs: School of Public Health > Epidemiology
Degree: MPH - Master of Public Health
Thesis Type: Master Essay
Refereed: Yes
Uncontrolled Keywords: obstetric, gynecology, hysterectomy, pathway
Date Deposited: 02 Feb 2021 19:12
Last Modified: 02 Feb 2023 06:15

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