Soria-Aledo Víctor, Flores-Pastor Benito, Candel-Arenas Mari Fe, Carrillo-Alcaraz Andrés, Campillo-Soto Alvaro, Miguel-Perelló Joana, Carrasco Prats Milagros, Aguayo-Albasini José Luis
Investigation Unit, "J.M. Morales Meseguer" University Hospital, Murcia, Spain.
Am Surg. 2008 Jan;74(1):29-36.
The aim of this study is to present the evaluation and monitoring of a clinical pathway for thyroidectomy 1 year after its implementation and after 4 years' follow up. We compare the results of an evaluation and monitoring indicators series before and after the establishment of the clinical pathway for thyroidectomy in the Surgery Department of Morales Meseguer Hospital, a general university hospital in Murcia, Spain. Implementation of the clinical pathway led to a reduction in length of hospital stay for all the surgery patients (4.8 +/- 2.1 and 3.6 +/- 1.9 days before and after pathway implementation, respectively; P < 0.001). Implementation of the clinical pathway led to a reduction in cost in all the operated patients (3357 +/- 966 and 2695 +/- 970 US$ before and after implementing the clinical pathway, respectively; P < 0.001). Evolution of the mean hospital cost according to year of study shows a reduction from 2000 (3400 +/- 1056 US$) to 2004 (2404 +/- 666 US$) with a slight increase during 2005 (2721 +/- 1335 US$) (P < 0.001). Implementation of the clinical pathway for thyroidectomy has successfully reduced clinical variation and therefore the length of hospital stay and mean cost of the process. In subsequent years, no such major improvements have been made with regard to hospital stay, although they are still clearly better than those before pathway implementation.
本研究旨在对甲状腺切除临床路径实施1年后及4年随访后的情况进行评估与监测。我们比较了西班牙穆尔西亚一所普通大学医院——莫拉莱斯·梅塞格尔医院外科甲状腺切除临床路径建立前后的一系列评估和监测指标结果。临床路径的实施使所有手术患者的住院时间缩短（路径实施前后分别为4.8±2.1天和3.6±1.9天；P<0.001）。临床路径的实施使所有手术患者的费用降低（实施临床路径前后分别为3357±966美元和2695±970美元；P<0.001）。根据研究年份显示的平均住院费用变化情况为，从2000年（3400±1056美元）降至2004年（2404±666美元），2005年略有增加（2721±1335美元）（P<0.001）。甲状腺切除临床路径的实施成功减少了临床差异，从而缩短了住院时间并降低了该过程的平均费用。在随后几年中，住院时间方面没有取得如此大的改善，尽管仍明显优于路径实施前。
