OBJECTIVES

THE VBC PROPOSES THAT THE FINAL OBJECTIVE OF ALL HEALTHCARE STAKEHOLDERS SHOULD FOCUS ON THE PATIENT’S RESULTS , DEFINED BY THE RELATIONSHIP BETWEEN PATIENT SATISFACTION, IMPROVEMENT OF HEALTHCARE STANDARDS AND OPTIMIZATION OF CARE'S COST PER CAPITA, DECREASING UNNECESSARY EXPENSES. THE FIRST BUNDLE MODEL WITH RISK SHARING IN LATIN AMERICA WAS IMPLEMENTED IN HAOC IN JULY/2017 AND THE CLINICAL/ECONOMIC DATA FROM PATIENTS SUBMITTED TO LAPAROSCOPIC BARIATRIC SURGERY PROCEDURE WERE COLLECTED IN ORDER TO VALIDATE THE SUSTAINABILITY OF THIS INNOVATIVE MODEL.

METHODS

THIS NON-INTERVENTIONAL AND RETROSPECTIVE STUDY CAPTURED THE CLINICAL AND RESOURCE USE DATA FROM THE HOSPITAL ADMINISTRATIVE DATABASE OF THE ELIGIBLE PATIENTS WHO UNDERWENT THE BARIATRIC SURGERY FROM JULY/2017 TO JULY/2018. THE PATIENTS WERE REFERRED FROM BOTH PUBLIC AND PRIVATE HEALTHCARE SYSTEMS AND WERE FOLLOWED FOR 30 DAYS POSTOP. THE RESULTS WERE COMPARED WITH NATIONAL DATA OBTAINED FROM A BRAZILIAN PRIVATE HEALTHCARE DATABASE, AS WELL AS LITERATURE. DIRECT COSTS WERE OBTAINED FROM HAOC AND OTHER BRAZILIAN DATABASES.

RESULTS

EIGHTY-THREE PATIENTS WERE OPERATED, 45 (54.2%) FROM THE PUBLIC HEALTH SYSTEM (SUS) WHERE BASELINE FACTORS THAT COULD INFLUENCE NEGATIVELY IN THE OUTCOMES (AGE, BMI AND COMORBIDITIES SUCH AS DIABETES AND HYPERTENSION) WERE CLINICALLY MORE SEVERE. HOWEVER, EITHER IN PUBLIC OR PRIVATE HEALTHCARE PATIENTS, THE MODEL WAS EFFECTIVE. THE RATES OF THE MAJOR INDICATORS FOR BARIATRIC SURGERY WHEN COMPARED WITH LITERATURE AND NATIONAL DATA (COMPARATOR) WERE: REOPERATION (0% VERSUS 1.8%), REHOSPITALIZATION (0% versus 2.3%), INTENSIVE CARE UNIT USE (1.2% versus 4.0%), EMERGENCY ROOM USE (6.0% versus 15.0%), COMPLICATIONS (1.4% versus 2.6%) AND HOSPITALIZATION LENGTH OF DAYS (2.0 VERSUS 2.5), RESULTING IN POTENTIAL SAVINGS OF BRL 1,918/PROCEDURE.

CONCLUSIONS

VBC MODEL IN HAOC FOR BARIATRIC SURGERY RESULTED IN AN OPTIMAL USE OF RESOURCES AND ROBUST CLINICAL OUTCOMES WHEN COMPARED TO THE BENCHMARK.