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Melanie Cole (Host): If you’re considering bariatric surgery you might want to know about national standards for bariatric surgery centers with a goal of advancing safe and high quality care for bariatric surgery patients. My guest to tell us about that today is Dr. John Yadegar. He’s the chief of surgery and medical director of the Metabolic and Bariatric Surgery Center at Palmdale Regional Medical Center. Dr. Yadegar, tell us a little bit about the bariatric program at Palmdale Regional Medical Center. Tell us about that first.

Dr. John Yadegar (Guest): Good morning and thanks for the opportunity. So the program that is currently in existence at the Palmdale Regional Medical Center has been here for 15 years and it was at from its infancy with one thing in mind which was really optimal patient outcome at patient care, and to that end, when we started the program it was a multidisciplinary program with the approach being very critically driven and so we wanted to make sure that everything was done very algorithmically which means that there’s a very standardized process. Of course it is individualized for every patient but based on those standards. Over the course of the year as the numbers of patients that are operated on and were treated through the program, these numbers have been nationally gathered and studied and we’ve had outcomes that have been outstanding, and as part of this we were accredited by the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program, which in short is MBSAQIP and the program got certified through this institution, the American Society of Metabolic and Bariatric Surgery three years ago and it’s every three year renewal and in fact we are about to go for recertification in the next two/three months, and it is a way of assessing the safety of the programs nationally in the United States. Of course, it sets the standard platform for other insurance carriers to follow, and so as a result of these standards of excellence that we achieved, we then were granted standard of excellence by other insurance carriers, which include the Blue Cross/Blue Shield and Cigna and some of the other programs that utilize us, again have their own requirements. It is a way of ensuring that all the programs follow standards of care with good outcomes that are reportable and that allows us to always look for improvements and make it better and it’s an ongoing process and so we were very proud of the team that has really worked very hard to achieve this and we are very grateful to our patients for allowing us to continue their care.

Melanie: Doctor, what did you have to do to earn this designation and also tell us what types of care are involved? Does it require the management of several aspects of care with improved coordination between providers?

Dr. Yadegar: So the important thing of course is data entry and you have to make sure that the individuals who study these patient populations are familiar with the importance of entering the correct and relevant data. Now these include suitability of the patient, the patient selection criteria, how they did after which particular kind of surgery, how long were they in the hospital, when they left how well did they do, whether they had potential complications that made them come back to the hospital, if they continue to do follow up, and the follow ups are usually quarterly and if they continue to improve as far as their weight loss, and improvement in their comorbidities, which are conditions such as diabetes, blood pressure, cholesterol, sleep apnea, and so we track all of these to make sure that as a result of their weight loss they’ve actually gotten rid of their diabetes, they’ve gotten rid of their blood pressure, and therefore the surgery that they did complete has led them to better quality of life. When you have all of that data entered and you compare nationally with other institutions and you know that the patients have good follow up and good outcomes, that allows the institutions to say okay, so we are doing a very good job and we just build on that. So the team that is put together is a team of qualified physicians, nurses, nutritionists, psychiatrists, and all the nurses who follow the patient particularly the nurse coordinator, and all of that together constitutes a strong program, and that’s really exemplified at the program at Palmdale.

Melanie: Well it certainly is a multidisciplinary approach to bariatric surgery. Tell us how you have to maintain to keep this designation, certain physical resources, and you’ve mentioned reporting. So speak about how all that works together for standard of practice.

Dr. Yadegar: Right so the data that is gathered and entered is then put in through the MBSQIP survey system, and then every quarterly, these numbers are looked at and based on those, the reports are fed back to the program to say well based on our review you seem to have a very good 30 day outcome. You’ve had no returns to the emergency room, no potential complications, and actually in the last quarter when this was audited we ended up having exemplary in two of those criteria in that we had had no potential return back to surgery, no returns back to the hospital, no returns for complications. So when you get these differentials assessed and if there are areas that you need to troubleshoot, it gives the institution an opportunity to improve their performance. As we said, it’s ongoing, so these data that are put in and are analyzed the feedback comes back to the institution and you make the adjustments. Of course every three years when you have the overall oversight before you recertify, all of that is going to be taken into consideration.

Melanie: So wrap it up for us, what would you like listeners to know about this exemplary distinction that you’ve received, and why it’s so important for a center, a bariatric center, to have this designation.

Dr. Yadegar: So the patients who have obesity and challenges associated with that often come in reasonably well informed because they’ve studied and they have talked to other patients and they have been on the web and they have kind of looked into the options that they have, but I would probably like to emphasize that it’s very important to be very educated about the options that you have and the facility that you decide to have the surgery in and the reason why that is, is that you want to make sure that the center that you go is well tuned in to the needs and the holistic needs of the patient, and that will include not just getting the surgery, it includes all the affiliations and all the stuff associated with after care. Am I going to have access to nutritionist? Am I going to have access to the surgeon? Am I going to have access to the nurses? Am I going to have good follow up? Am I going to have good education, good instruction? Because in the older days when some of the programs were just operate and the patient was not really well informed and had no follow up, the outcomes suffered and so we want to make sure that our patients are well informed. That when they look into choosing the surgeon and the hospital, that they make sure that they are accredited surgeons, accredited programs, and that they have a good track record, and that they look at all of those, so that way they ensure that they are in good hands, and God willing they go onto have the surgery with good outcomes and improvement with the quality of life. We are very blessed that we have had a very good support system and we have managed to achieve the standard that we have and we are very proud of it, and as I said we continue to strive to improve upon that every day and it’s important for the patient when they meet the surgeon that they have a comfortable connection, because you know it’s going to be an ongoing process and you want to make sure that the physician and the patient have that established comfort zone that are going to continue this relationship long term because that’s good for the patient, it’s good for the practice, and it makes sure that you have good insight as a physician to your patient and has a patient to the practice and it’s a marriage and we want the patient to look into that from the very get go, to feel comfortable with what they’re committed themselves to. So I hope that anyone who’s considering this really takes the time to evaluate all of those before they make that decision.

Melanie: So important and thank you so much for explaining what that means and what that designation means for patients as far as a good quality bariatric surgery center. Thank you again for joining us. You’re listening to Palmdale Regional Radio with Palmdale Regional Medical Center. For more information, please visit palmdaleregional.com. Physicians are independent practitioners who are not employees or agents of Palmdale Regional Medical Center. The hospital shall not be liable for actions or treatments provided by physicians. Individual results may vary. There are risks associated with any surgical procedure. Speak with your physician about these risks to find out if bariatric surgery is right for you. This is Melanie Cole, thanks for listening.