Hysterectomy Pathway as the Global Engine of Practice Change: Implications for Value in Care

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Amin Sanei-Moghaddam
Sharon Goughnour
Robert Edwards
John Comerci
Joseph Kelley
Nicole Donnellan
Faina Linkov
Suketu Mansuria


Introduction: In 2012, University of Pittsburgh Medical Center (UPMC) introduced a hysterectomy clinical pathway to reduce the number of total abdominal hysterectomies performed for benign gynecological indications. This study focused on exploring physician and patient factors impacting the utilization of hysterectomy clinical pathways.

Methods: An online survey with 24 questions was implemented to explore physicians’ attitudes and perceived barriers toward implementing the pathway. A survey consisting of 27 questions was developed for patients to determine the utility of a pathway-based educational tool for making surgery decisions and to measure satisfaction with the information provided.  Descriptive statistics were used to describe survey results, while thematic analysis was performed on verbal feedback submitted by respondents. 

Results: Physician respondents found the clinical pathway to be practical, beneficial to patients, and up-to-date with the latest evidence-based literature. Key barriers to the use of the pathway that were identified by physicians included perceived waste of time, inappropriateness for some of the patient groups, improper incentive structure, and excessive bureaucracy surrounding the process.  Overall, patient respondents were satisfied with the tool and found it to be helpful with the decision-making process of choosing a hysterectomy route. 

Conclusions: Physicians and patients found the developed tools to be practical and beneficial. Findings of this study will help to use pathways as a unifying framework to shape future care of patients needing hysterectomy and add value to their care.

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How to Cite
Sanei-Moghaddam, A., Goughnour, S., Edwards, R., Comerci, J., Kelley, J., Donnellan, N., Linkov, F., & Mansuria, S. (2017). Hysterectomy Pathway as the Global Engine of Practice Change: Implications for Value in Care. Central Asian Journal of Global Health, 6(1). https://doi.org/10.5195/cajgh.2017.299


CDC. Inpatient Surgery. CDC/National Center for Health Statistics. http://www.cdc.gov/nchs/fastats/inpatient-surgery.htm. Accessed September 24, 2017.

Wright JD, Herzog TJ, Tsui J, et al. Nationwide trends in the performance of inpatient hysterectomy in the United States. Obstet Gynecol. 2013;122(2 Pt 1):233-241.

Wu JM, Wechter ME, Geller EJ, Nguyen TV, Visco AG. Hysterectomy rates in the United States, 2003. Obstet Gynecol. 2007;110(5):1091-1095.

Sanei-Moghaddam A, Ma T, Goughnour SL, et al. Changes in Hysterectomy Trends After the Implementation of a Clinical Pathway. Obstetrics and gynecology. 2016;127(1):139-147.

Gandaglia G, Ghani KR, Sood A, et al. Effect of minimally invasive surgery on the risk for surgical site infections: results from the National Surgical Quality Improvement Program (NSQIP) Database. JAMA Surg. 2014;149(10):1039-1044.

AAGL. AAGL position statement: route of hysterectomy to treat benign uterine disease. J Minim Invasive Gynecol. 2011;18(1):1-3.

ACOG. ACOG Committee Opinion No. 444: choosing the route of hysterectomy for benign disease. Obstet Gynecol. 2009;114(5):1156-1158.

Pearson S. Et tu, critical pathways? Am J Med. 1999;107:397-398.

Rotter T, Kinsman L, James E, et al. Clinical pathways: effects on professional practice, patient outcomes, length of stay and hospital costs. The Cochrane database of systematic reviews. 2010(3):Cd006632.

Hripcsak G, Ryan PB, Duke JD, et al. Characterizing treatment pathways at scale using the OHDSI network. Proc Natl Acad Sci U S A. 2016;113(27):7329-7336.

Mansuria SM CJ, Edwards R, Sanei Moghaddam A, Ma T, Linkov F. Changes in Hysterectomy Trends and Patient Outcomes Following the Implementation of a Clinical Pathway. Obstet Gynecol. 2016;127:1-3s.

Healthwise Incorporated. 2016; http://www.healthwise.org/about.aspx. Accessed September 24, 2017.

Qualtrics Survey Service. 2015; http://technology.pitt.edu/service/qualtrics-survey-service. Accessed September 24, 2017.

Braun V, Clarke, V. Using thematic analysis in psychology. Qual Res Psychol. 2006;3:77-101.

O'Connor AM, Tugwell P, Wells GA, et al. A decision aid for women considering hormone therapy after menopause: decision support framework and evaluation. Patient Educ Couns. 1998;33(3):267-279.

Tariman JD, Berry DL, Cochrane B, Doorenbos A, Schepp K. Preferred and actual participation roles during health care decision making in persons with cancer: a systematic review. Ann Oncol. 2010;21(6):1145-1151.

Lenz R, Blaser R, Beyer M, et al. IT support for clinical pathways--lessons learned. Int J Med Inform. 2007;76 Suppl 3:S397-402.

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