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What are VitalSource eBooks? For Instructors Request Inspection Copy. Non-invasive options for the management of gynecologic conditions continue to grow in popularity, as they offer considerable benefits in reduced patient stress, hospitalization time, and cost. Non-invasive Management of Gynecologic Disorders provides an informative, concise, and highly practicable resource for the diagnosis and management of gynecologic disorders for which non-surgical treatment options are available. An evidence—based approach is followed through-out the book.

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Non-invasive Management of Gynecologic Disorders is a valuable source in offering guidance to physicians on how and when it is appropriate to choose more conservative modalities and also to differentiate between the variety of treatment options available. Bump or Narender N. We provide complimentary e-inspection copies of primary textbooks to instructors considering our books for course adoption.

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Description Table of Contents Editor s Bio. Summary Non-invasive options for the management of gynecologic conditions continue to grow in popularity, as they offer considerable benefits in reduced patient stress, hospitalization time, and cost. Table of Contents 1. This intervention — introducing a clinical decision pathway to encourage minimally invasive hysterectomies for noncancerous conditions — led to improved patient outcomes and value of care.

In other words, costs went down while quality went up. Hysterectomy, the surgical removal of the uterus, is the second most common surgery among women in the United States, after cesarean section. Leading professional organizations recommend the use of minimally invasive approaches for benign indications over total open abdominal hysterectomy, which is associated with higher risks of complications, length of hospital stay, and costs.

Despite the benefits of minimally invasive surgery , evidence points to excessive use of open surgery for hysterectomy. Traditionally, gynecologic surgeons have passed on their craft to succeeding generations through apprenticeship, favoring more invasive surgical approaches. Barriers include lack of provider awareness and acceptance of new clinical practice guidelines. While behavior change is a process, not an event, little is known about how to influence surgeon behavior.

In , the UPMC Health System introduced an evidence-based hysterectomy decision-making algorithm for physicians treating patients with benign gynecologic conditions. It features the active involvement of both the surgeon and patient at all stages of the treatment process.

Obstetrics and Gynecology

Clinical pathways represent a shift from opinion-based practice to evidence-based practice. Decision support tools have been shown to help providers and patients make informed decisions , especially where many options are available with various degrees of risks and benefits.


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Research suggests they may also increase patient involvement, help set realistic expectations of outcomes, and improve patient-provider communication. This case study describes how we changed the paradigm for hysterectomies by introducing measures affecting both surgeon and patient. To successfully develop, implement, and disseminate an evidence-based clinical pathway decision tool for noncancerous gynecologic conditions to reduce variation and uncertainty in the surgical decision-making process. We aimed to decrease abdominal hysterectomy rates, improve patient outcomes, and contain costs by increasing the use of minimally invasive hysterectomies laparoscopic hysterectomy, vaginal hysterectomy, and robotic-assisted laparoscopic hysterecomy.

Improving the consistency of decision-making by collaborating with physicians, and effectively analyzing the factors that influence decision-making, are critically important for enhancing the quality of care. Our practical approach includes concrete steps that health care systems can implement to influence physician behavior in a sustainable way, and in various settings, both locally and internationally. The key processes for introducing evidence-based guidelines across UPMC institutions involved engaging stakeholders in developing and assessing the hysterectomypathway, ensuring provider and patient education, establishing incentives, and integrating the tool into the electronic medical record EMR.

Another goal was to prioritize patient involvement in treatment decisions and establish a patient-centered approach. Click To Enlarge. Establish clinical pathway: The UPMC team thoroughly investigated both evidence in the literature and local practice patterns to develop standardized guidelines for physicians on hysterectomy approaches.

It is important to note that this hysterectomy pathway focuses on the treatment of benign disease, with cancerous conditions potentially requiring different approaches. Physician engagement: Physicians were prospectively engaged in the clinical pathway development. A core group including surgeons, anesthesiologists, mid-level providers, and administrators convened to review and disseminate evidence-based literature, develop dashboards to compare physician performance, and present the project to different departments. Physicians also helped create the incentive structure for practices that follow the hysterectomy pathway.

Patient education: Patient education plays a key role in treatment success, but sharing information can be time-consuming for clinicians. These include the Emmi videos and Healthwise printable booklets systems. Paper-based materials posted on the UPMC website were also used in our research studies on pathway evaluation.

Provider education: Surgeons had the opportunity to train in minimally invasive techniques by observing and assisting established specialists. A recent evaluation of approaches for influencing physician behavior found that — consistent with our findings — active forms of continuing medical education such as workshops and tailored interventions are more effective for incorporating guidelines into general practice than passive methods, such as distributing printed materials.

Physician dashboard: Our health care system addressed practice variations by creating electronic physician dashboards that allow gynecologic surgeons to compare their clinical performance to other surgeons. The dashboard focused on metrics pertaining to quality of care, consistency, and reproducibility. Open hysterectomy rates, as well as quality and cost metrics, were presented in a blinded fashion, with surgeons inherently driven to not be outliers.

Non-Invasive Management of Gynecologic Disorders

These dashboards played an important role in reducing open hysterectomy rates. They allowed us to engage physicians in a non-coercive, positive inquiry about their practice patterns.


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No punitive actions were taken against non-users. Pathway use is not required of physicians, but those who do not must justify their decision. Financial Incentives: The initial stage of clinical pathway integration included group financial incentives for participating providers.

Supplemental pay group bonus given to a whole practice with good pathway adherence was later introduced for providers who performed above a particular threshold. EMR Integration: Integrating the decision tool into the electronic medical record system was central to the initiative and to engaging patients and providers.

Minimally Invasive Gynecologic Surgery - Gynecological Services | NYU Winthrop Hospital

It allowed for prospective measurement of pathway use and the proper application of pathway guidelines. Our team consisted of physicians anesthesiologists, oncologists, gynecologists, urogynecologists, etc. For example:.