Dissertation (Masters) Cost-effective Care Delivery Models in Ambulatory Surgery: Expedited Discharge and Virtual Care


Kathleen Armstrong


My Master’s thesis applies the Value Agenda framework to the ambulatory breast reconstruction population.

The first study uses patient level quality of recovery (QoR) data to determine if autologous breast reconstruction is suitably performed in an ambulatory facility. We found that QoR scores approach baseline by postoperative day 7; and are comparable to other ambulatory surgery patient populations. In keeping with the Value Agenda, this study uses patient outcome data to support autologous breast reconstruction in more cost-effective, ambulatory facilities.

The second study models the cost-effectiveness of replacing in-person follow-up care with mobile app follow-up care during the first month following ambulatory breast reconstruction. We found a societal incremental net benefit of $245 CAD between mobile app and in-person follow-up care. Mobile app follow-up care expands the geographical reach of breast reconstruction by reducing the burden of physical patient travel and its associated costs after surgery.


Peter C. Coyte


Sacha Bhatia