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The Association Between Clinical Pathways and Hospital Length of Stay: A Case Study

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Abstract

Clinical pathways are the treatment protocol in order to reduce or eliminate variation of care by specifying to nursing and medical staff. The effectiveness of the clinical pathways to accomplish this goal, however, is in question. With the implementation of the clinical pathways in 2001, this study evaluates the effectiveness of clinical pathway in reducing the inpatient length of stay in a rural hospital in a Midwestern state. All inpatient cases were used with the primary diagnoses of chronic obstructive pulmonary disease, congestive heart failure, diabetes, myocardial infarction, and pneumonia from the years of 1999–2003. By controlling for gender, age, insurance type, and year, this study employs a multiple regression analysis to evaluate the association between clinical pathways and the length of stay. Only one (the clinical pathway for myocardial infarction) out of the five pathways studied showed an association with a statistical significance in decreasing the length of stay. Health care administrators should consider other aspects as well as the hospital length of stays when implementing clinical pathways in their facility.

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References

  1. Shi, L., and Singh, D. A., Delivering Health Care in America: A Systems Approach, Johns and Bartlett Publishers, Sudbury, MA, 2004.

    Google Scholar 

  2. Williams, S., and Torrens, P. R., Introduction to Health Services 6th edition, Delmar Thomson Learning, Albany, NY, 2002.

    Google Scholar 

  3. Barton, P. L. Understanding the U.S. Health Services System 2nd edition, Health Administration Press, Chicago, IL, 2003.

    Google Scholar 

  4. Ramos, M. C., The successful utilization of financial data in the support of care management. Fam. Community Health 22(3):49–63, 1999.

    Google Scholar 

  5. Saint, S., Hofer, T. P., Rose, J., Kaufman, S. R., and McMahon, L. F., Use of critical pathways to improve efficiency: a cautionary tale. Am. J. Managed Care 9:91–98, 2003.

    Google Scholar 

  6. Lippman, H., The bottom line on length of stay. Bus. Health 19(4):35–38, 2001.

    Google Scholar 

  7. Ramsey, C., Ormsby, S., and Marsh, T., Performance-improvement strategies can reduce costs. Healthc. Financ. Manage. 54(12):2–6, 2001.

    Google Scholar 

  8. Teke, K., Kisa, A., Demir, C., and Ersoy, K., Appropriateness of admission and length of stay in a Turkish Military Hospital. J. Med. Syst. 28(6):653–663, 2004.

    Article  Google Scholar 

  9. Weaver, F. M., Guihan, M., Hynes, D. M., Byck, G., Conrad, K. J., and Demakisi, J. G., Prevalence of subacute patients in acute care: results of a study of VA hospitals. J. Med. Syst. 22(3):161–172, 1998.

    Article  Google Scholar 

  10. Cheney, J., Barber, S., Altamirano, L., Medico, C., Cirujano, M., Williams, C., Jackson, M., Yates, M., O’Rourke, P., and Wainwright, C., A clinical pathway of Bronchiolotis is effective in reducing readmission rates. J. Pediatrics 147(5):622–626, 2005.

    Article  Google Scholar 

  11. Munoz, J., Garcia, D., Perez, R., and Sanjurjo, M., Clinical pathway for hip arthroplasty six years after introduction. Int. J. Health Care Qual. Assur. 19(3):237–245, 2006.

    Article  Google Scholar 

  12. Lemberg, D. A., Day, A. S., and Brydon, M., The role of a clinical pathway in curtailing unnecessary investigations in children with gastroenteritis. Am. J. Med. Qual. 20(2):83–88, 2005.

    Article  Google Scholar 

  13. Uchiyama, K., Takifuji, K., Tani, M., Onishi, H., and Yamaue, H., Effectiveness of the clinical pathway to decrease length of stay and cost for laparoscopic surgery. Surg. Endosc. 16:1594–1597, 2002.

    Article  Google Scholar 

  14. Ranjan, A., Tarigopula, L., Srivastava, R., Obasanjo, O., and Obah, E., Effectiveness of the clinical pathway in the management of congested heart failure. South. Med. J. 96(7):661–663, 2003.

    Article  Google Scholar 

  15. Madan, A. K., Speck, K. E., Ternovits, C. A., and Tichansky, D. S., Outcome of a clinical pathway for discharge within 48 hours after laparoscopic gastric bypass. Am. J. Surg. 192(3):399–402, 2006.

    Article  Google Scholar 

  16. Pritts, T. A., Nussbaum, M. S., Flesch, L. V., Fegelman, E. J., Parikh, A. A., and Fischer, J. E., Implementation of a clinical pathway decreases length of stay and cost for bowel resection. Ann. Surg. 230(5):728–733, 1999.

    Article  Google Scholar 

  17. Bleser, L., Depreitere, R., Waele, K. D., Vanhaecht, K., Vlayen, J., and Sermeus, W., Defining pathways. J. Nurs. Manag. 14(7):553–563, 2006.

    Article  Google Scholar 

  18. Mardis, R., and Brownson, K., Length of stay at all-time low. Health Care Manag. 22(2):122–127, 2003.

    Google Scholar 

  19. Isozaki, L. F., and Fahndrick, J., Clinical pathways – A perioperative application. AORN J. 67(2):376, 379–86, 389–92, 1998.

    Article  Google Scholar 

  20. Renholm, M., Leino-Kilpi, H., and Suominen, T., Critical pathways: A systematic review. J. Nurs. Adm. 32:196–202, 2000.

    Google Scholar 

  21. Kaya, S., Eroglu, K., Vural, G., Shwartz, M., Restuccia, J. D., Factors affecting appropriateness of hospital utilization in two hospitals in Turkey. J. Med. Syst. 25(6):373–383, 2001.

    Article  Google Scholar 

  22. Eisenberg, J. M., Physician utilization: The state of research about physician’s practice patterns. Med. Care 23(5):461–483, 1985.

    Article  Google Scholar 

  23. Deyo, R. A., and Patrick, D. L., The significance of treatment effects: The clinical perspective. Med. Care 33(4):AS286–AS291, 1995.

    Google Scholar 

  24. Greenfield, S., and Nelson, E. C., Recent developments and future issues in the use of health status assessment measures in clinical settings. Med. Care 30(5) Supp:MS23–MS41, 1992.

    Article  Google Scholar 

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Correspondence to Keon-Hyung Lee.

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Lee, KH., Anderson, Y.M. The Association Between Clinical Pathways and Hospital Length of Stay: A Case Study. J Med Syst 31, 79–83 (2007). https://doi.org/10.1007/s10916-006-9045-9

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