Author Affiliations: Hospital Medicine Section, University of Colorado Denver, Aurora, Colorado.
We read with interest the article by Auerbach and colleagues1 and believe it highlights several important issues for the nascent field of surgical comanagement.
First, the lack of significant improvement in traditional quality indicators underscores the need to study alternative quality measures. A comanagement model may not be able to alter the length of stay, mortality, or readmission rate following an elective surgical procedure with a defined postoperative course or intraoperative mortality. However, a model that fundamentally re-engineers systems of care may have an impact on outcomes such as deep venous thrombosis, pain, delirium, and catheter use and infection rates. These complications may not prolong the length of stay and will not be detected in administrative data.
Levin D, Glasheen JJ. Achieving Comanagment’s Potential Requires System Redesign and Hospitalist-Focused Training. Arch Intern Med. 2011;171(14):1299–1300. doi:10.1001/archinternmed.2011.323