Ghosh K, Downs L S, Padilla L A, Murray K P, Twiggs L B, Letourneau C M, Carson L F
Division of Gynecologic Oncology, University of Minnesota Medical Center, Minneapolis, Minnesota 55455, USA.
Gynecol Oncol. 2001 Nov;83(2):378-82. doi: 10.1006/gyno.2001.6428.
The aim of the study is to determine whether critical pathways can be implemented at an academic institution to limit cost, without compromising patient satisfaction and quality of care.
Patients undergoing a hysterectomy with either cervical or endometrial cancer were placed on specific critical pathways consecutively for an 18-month study period. Preoperative teaching was intensified to educate the patient regarding expectations during the postoperative period. All patients were started on early feeding and patients were also placed on separate care pathways addressing pain and deep vein thrombosis prophylaxis. Total direct costs and patient satisfaction were obtained throughout the study period. During the year prior to care pathway implementation, patient data and direct costs were obtained for the preintervention group utilized for comparison. Postintervention groups were summarized every 6 months during the study period.
From January 1997 through June 1998, 63 patients with cervical carcinoma undergoing a radical hysterectomy (DRG 353) and 21 patients with endometrial cancer who underwent a hysterectomy and lymph node sampling (DRG 355) were utilized as the preintervention group. During the 18-month study period (July 1998-December 1999), 42 patients (DRG 353) and 25 patients (DRG 355) were accrued. The average length of stay was reduced from 5.2 (DRG 353) and 4.7 days (DRG 355) prior to implementation of pathways to 3.4 days in both groups. In addition, total direct costs were reduced by 29 (DRG 353) and 32% (DRG 355) after implementation of care pathways. Patient satisfaction data recorded during the study did not demonstrate any change throughout the study period nor were there any higher rates of readmission after implementation of the care pathways.
Critical pathways in gynecologic oncology can be implemented in a managed care environment in order to maintain high quality of care, maintain outcomes, and help reduce costs.
本研究旨在确定在不影响患者满意度和医疗质量的前提下，学术机构是否可以实施关键路径以控制成本。
在为期18个月的研究期间，对因宫颈癌或子宫内膜癌接受子宫切除术的患者连续采用特定的关键路径。加强术前教育，让患者了解术后预期情况。所有患者均开始早期进食，并针对疼痛和深静脉血栓形成预防采用单独的护理路径。在整个研究期间获取总直接成本和患者满意度数据。在实施护理路径前一年，获取用于比较的干预前组患者数据和直接成本。在研究期间，每6个月对干预后组进行总结。
从1997年1月至1998年6月，63例接受根治性子宫切除术的宫颈癌患者（疾病诊断相关分组353）和21例接受子宫切除术及淋巴结取样的子宫内膜癌患者（疾病诊断相关分组355）被用作干预前组。在18个月的研究期间（1998年7月至1999年12月），纳入了42例患者（疾病诊断相关分组353）和25例患者（疾病诊断相关分组355）。两组的平均住院时间从实施路径前的5.2天（疾病诊断相关分组353）和4.7天（疾病诊断相关分组355）降至3.4天。此外，实施护理路径后，总直接成本分别降低了29%（疾病诊断相关分组353）和32%（疾病诊断相关分组355）。研究期间记录的患者满意度数据在整个研究期间未显示任何变化，实施护理路径后再入院率也未升高。
妇科肿瘤学中的关键路径可在管理式医疗环境中实施，以维持高质量的医疗服务、保持治疗效果并有助于降低成本。
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