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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Shi, L., and Singh, D. A., Delivering Health Care in America: A Systems Approach, Johns and Bartlett Publishers, Sudbury, MA, 2004.
Williams, S., and Torrens, P. R., Introduction to Health Services 6th edition, Delmar Thomson Learning, Albany, NY, 2002.
Barton, P. L. Understanding the U.S. Health Services System 2nd edition, Health Administration Press, Chicago, IL, 2003.
Ramos, M. C., The successful utilization of financial data in the support of care management. Fam. Community Health 22(3):49–63, 1999.
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.
Lippman, H., The bottom line on length of stay. Bus. Health 19(4):35–38, 2001.
Ramsey, C., Ormsby, S., and Marsh, T., Performance-improvement strategies can reduce costs. Healthc. Financ. Manage. 54(12):2–6, 2001.
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.
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.
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.
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.
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.
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.
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.
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.
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.
Bleser, L., Depreitere, R., Waele, K. D., Vanhaecht, K., Vlayen, J., and Sermeus, W., Defining pathways. J. Nurs. Manag. 14(7):553–563, 2006.
Mardis, R., and Brownson, K., Length of stay at all-time low. Health Care Manag. 22(2):122–127, 2003.
Isozaki, L. F., and Fahndrick, J., Clinical pathways – A perioperative application. AORN J. 67(2):376, 379–86, 389–92, 1998.
Renholm, M., Leino-Kilpi, H., and Suominen, T., Critical pathways: A systematic review. J. Nurs. Adm. 32:196–202, 2000.
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.
Eisenberg, J. M., Physician utilization: The state of research about physician’s practice patterns. Med. Care 23(5):461–483, 1985.
Deyo, R. A., and Patrick, D. L., The significance of treatment effects: The clinical perspective. Med. Care 33(4):AS286–AS291, 1995.
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.
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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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DOI: https://doi.org/10.1007/s10916-006-9045-9