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Avalere Health Releases Enhanced Recovery White Paper

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"On June 10, 2014, the Center for Medical Technology Policy (CMTP) in collaboration with Avalere Health hosted a multi-stakeholder forum in Baltimore, Maryland, to discuss potential challenges and opportunities to accelerate the adoption of enhanced recovery protocols (ERPs) in the U.S.

This week, forum participants, including Avalere’s Kristi Mitchel and Nelly Ganesan, released a white paper in summation.

Literature shows that 25 percent of patients who undergo surgery in the U.S. have post-surgical complications (H. Kehlet, D.W. Wilmore). Goal-directed fluid therapy, a key component of enhanced recovery, has been demonstrated to reduce these complications by anywhere from 32% to 55% (J.D. Birkmeyer, J.B. Dimick, D.O. Staiger, et al.). With approximately 10 million patients in the U.S. undergoing surgery every year, many of these patients may have an opportunity to prevent surgical complications through the implementation of ERPs.

To tackle some of these healthcare related challenges, stakeholders representing surgeons, anesthesiologists, nurses, patients, medical products companies, health system administrators, payers, quality organizations, and researchers gathered to discuss potential strategies and programs to improve outcomes for patients undergoing major surgery. Speakers shared lessons learned from implementing enhanced recovery programs at their own institutions, while the group discussed the potential barriers to accelerating adoption of such programs in the U.S. and brainstormed potential strategies to overcome those barriers.

One of the clear insights from the June 10 meeting was the recognition that collaboration is key to the success of advancing the use and adoption of ERPs in the U.S. Examples from the U.K. showcased the need for increased communication between surgeons and anesthesiologists both in understanding the ownership of certain processes related to pre-operative care and also a clear partnership in care delivery. The meeting allowed participants to express concerns and identify potential policy solutions to further advance the adoption of ERPs and also the impact this adoption could have on patients.

During the second half of the forum, participants identified the needs to institute a multi-stakeholder agenda to advance enhanced recovery for U.S. surgical patients. Various solutions included:

  1. Establish a neutral forum for ongoing and transparent national stakeholder dialogue
  2. Identify stakeholder evidence needs and generate data
  3. Identify and develop quality measures related to enhanced recovery
  4. Test measures in new payment and delivery models
  5. Generate visible support from U.S. leaders for broad adoption of ERPs in practice
  6. Create national awareness and public demand for the adoption of enhanced recovery programs

As a whole, meeting participants expressed a high level of excitement and energy as well as a strong sense of trust and partnership, emphasizing the need to rapidly capitalize on the success of the meeting to build momentum for work to accelerate adoption of ERPs. This group, including Avalere, will continue to work toward many of these solutions in the coming months.

For more information, please contact Nelly Ganesan.

The one-day multi-stakeholder meeting was supported by funds from Edwards LifeSciences. CMTP and Avalere Health developed the agenda and facilitated the discussion.

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