Improvement of health outcomes after continued implementation of a clinical pathway for radical nephrectomy

被引：16

作者：

Chang, PL ^{[1
]}

Wang, TM ^{[1
]}

Huang, ST ^{[1
]}

Hsieh, ML ^{[1
]}

Chuang, YC ^{[1
]}

Chuang, CH ^{[1
]}

机构：

[1] Chang Gung Mem Hosp, Dept Urol, Tao Yuan, Taiwan

来源：

WORLD JOURNAL OF UROLOGY | 2000年 / 18卷 / 06期

关键词：

D O I：

10.1007/s003450000158

中图分类号：

R5 [内科学]; R69 [泌尿科学（泌尿生殖系疾病）];

学科分类号：

1002 ; 100201 ;

摘要：

The clinical pathway is an important tool for outcome management. We evaluated the overall effects of the continued implementation of a clinical pathway for radical nephrectomy on the length of hospital stay, admission charges, and the quality of medical care. The data obtained from the second-year implementation (group 3) of the clinical pathway were compared with the data from the first-year implementation (group 2) and the year preceding implementation (group 1). Thirty-seven consecutive patients with renal cell carcinoma underwent radical nephrectomy in group 1, 47 in group 2, and 55 in group 3; all were enrolled in this study. The length of hospital stay, average admission charges, and 8 quality indicators were measured in these patients. We also evaluated the variances in the implementation of the clinical pathway. The mean length of stay decreased by 14.0% (P = 0.0048) in group 2, and by .15.8% (P = 0.0014) in group 3, when compared to group 1. The total admission charges significantly de creased by 19.0% (P = 0.001) in group 2, and by 27.9% (P < 0.0001) in group 3, compared to the charges for group 1. A continued decrease in charges for operation and anesthesia, laboratory, pharmacy, and others were found 2 years after implementation of the clinical pathway. Among the 8 quality indicators, 2 were continuously improved in the second-year implementation of the clinical pathway, 2 were improved significantly in the second-year implementation only, and 4 showed no significant change at all. Variances from the clinical pathway decreased significantly after continued implementation. Continued implementation of the clinical pathway for radical nephrectomy can improve a physician's practice continuously by decreasing the length of hospital stay, admission charges, and variances, and by improving quality. However, the improved results after implementation of the clinical pathway should be maintained carefully to assure good health care.

引用

页码：417 / 421

页数：5

共 17 条

[1] Implementation of a clinical pathway decreases length of stay and hospital charges for patients undergoing total colectomy and ileal pouch anal anastomosis [J].