Chang P L, Wang T M, Huang S T, Hsieh M L, Chuang Y C, Chang C H
Department of Urology, Chang Gung Memorial Hospital, Taoyuan, Taiwan.
World J Urol. 2000 Dec;18(6):417-21. doi: 10.1007/s003450000158.
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 decreased 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.
临床路径是结果管理的重要工具。我们评估了持续实施根治性肾切除术临床路径对住院时间、住院费用和医疗质量的总体影响。将临床路径第二年实施（第3组）获得的数据与第一年实施（第2组）和实施前一年（第1组）的数据进行比较。第1组连续37例肾细胞癌患者接受了根治性肾切除术，第2组47例，第3组55例；所有患者均纳入本研究。测量了这些患者的住院时间、平均住院费用和8项质量指标。我们还评估了临床路径实施中的差异。与第1组相比，第2组的平均住院时间减少了14.0%（P = 0.0048），第3组减少了15.8%（P = 0.0014）。与第1组的费用相比，第2组的总住院费用显著降低了19.0%（P = 0.001），第3组降低了27.9%（P < 0.0001）。临床路径实施两年后，手术及麻醉、实验室、药房等费用持续下降。在8项质量指标中，临床路径第二年实施时有2项持续改善，2项仅在第二年实施时有显著改善，4项无显著变化。持续实施后，临床路径的差异显著降低。持续实施根治性肾切除术的临床路径可通过缩短住院时间、降低住院费用和差异以及提高质量来持续改善医生的实践。然而，临床路径实施后的改善结果应谨慎维持，以确保良好的医疗保健。
