A systems innovation model: An integrated interdisciplinary team approach pre- and post-bariatric surgery at a veterans affairs (VA) medical center

Abstract Background Provision of bariatric surgery in the Veterans Health Administration (VHA) must account for obese Veterans’ comorbidity burden and the geographically dispersed location of patients relative to VA bariatric centers. Objective To evaluate a collaborative, integrated, interdisciplinary bariatric team of surgeons, bariatricians, psychologists, dietitians, and physical therapists working in a hub-and-spokes care model, for pre- and post-bariatric surgery assessment and management. Methods This is a description of an interdisciplinary clinic and bariatric program at a VA Health Care System, and a report on program evaluation findings. Retrospective data of a prospective database was abstracted. For program evaluation, we abstracted charts to characterize patient data, and conducted a patient survey. Results Since 2009, 181 Veterans underwent bariatric surgery. Referrals came from 7 western U.S. states. Mean pre-operative body mass index was 46 kg/m2 (maximum 71). Mean age was 53 years, with 33% over age 60; 79% were male. Medical comorbidity included diabetes (70%), hypertension (85%) and lower back or extremity joint pain (84%). A psychiatric diagnosis was present in 58%. At 12-months, follow-up was 81% and percent excess BMI loss (%EBMIL) was 50.5%. Among 54 sequential clinic patients completing anonymous surveys, overall satisfaction with the interdisciplinary team approach and improved quality of life were high (98% and 94%, respectively). Conclusions The integrated, interdisciplinary team approach using a hub-and-spoke model is well suited to the VA bariatric surgery population, with its heavy burden of medical and mental health comorbidity, and its system of geographically dispersed patients receiving treatment at specialty centers. As the VA seeks to expand the use of bariatric surgery as an option for obese Veterans, interdisciplinary models crafted to address case complexity, care coordination and long-term outcomes should be part of policy planning efforts.