Mine Yuko, Fujino Yoshihisa, Sabanai Ken, Muramatsu Keiji, Otani Makoto, Kubo Tatsuhiko, Fushimi Kiyohide, Matsuda Shinya
Department of Preventive Medicine and Community Health, School of Medicine, University of Occupational and Environmental Health, 1-1, Iseigaoka, Yahatanishiku, Kitakyushu, 807-8555, Japan; Secretariant of Japanese Physical Therapy Association, 3-8-5, Sendagaya, Shibuyaku, Tokyo, 151-0051, Japan.
Department of Environmental Epidemiology, Institute of Industrial Ecological Sciences, University of Occupational and Environmental Health, 1-1, Iseigaoka, Yahatanishiku, Kitakyushu, 807-8555, Japan.
J Orthop Sci. 2020 Jan;25(1):127-131. doi: 10.1016/j.jos.2019.02.002. Epub 2019 Feb 22.
Regional clinical pathways, a new type of clinical pathway, are practiced with the aim of standardizing and optimizing medical care by cooperation among multiple medical institutions in a region. However, current evaluation of the effectiveness of regional clinical pathways for hip fracture, a major health problem requiring hospitalization for orthopedic surgery, is insufficient. This study aimed to determine the association between regional clinical pathways and postoperative hospital length of stay (LOS) among hip fracture patients. In particular, we focused on the variation in postoperative LOS of hip fracture patients among hospitals and the contribution of regional clinical pathways to this variation.
Using data from the Diagnosis Procedure Combination (DPC) database in Japan from April 2011 to March 2013, patients who were diagnosed with "fracture of head and neck of femur" (ICD10 code S72.0) or "pertrochanteric fracture" (S72.1) and received "bipolar hip arthroplasty" or "open reduction and internal fixation" were extracted. A total of 110,133 patients were included. Associations between regional clinical pathways and postoperative LOS were analyzed using cross-sectional analysis with multilevel regression models.
Hospitals that implemented a regional clinical pathway showed a significant reduction (13 days) in the postoperative LOS of hip fracture patients. We found a 16% inter-hospital variation in postoperative LOS, which might be explained by hospital-level implementation of regional clinical pathways. Application of regional clinical pathways at the patient level resulted in a 4-day decrease in postoperative LOS.
Implementation of regional clinical pathways for hip fracture patients at the hospital level was associated with reduced postoperative LOS, regardless of whether or not pathways were implemented at the patient level. This suggests that regional clinical pathways are effective for patient care management in hospitals.
区域临床路径作为一种新型临床路径，旨在通过区域内多个医疗机构的合作来规范和优化医疗服务。然而，对于髋部骨折这一需要骨科手术住院治疗的重大健康问题，目前对区域临床路径有效性的评估尚不充分。本研究旨在确定区域临床路径与髋部骨折患者术后住院时间（LOS）之间的关联。特别是，我们关注了髋部骨折患者术后住院时间在不同医院之间的差异，以及区域临床路径对这种差异的影响。
利用日本诊断程序组合（DPC）数据库2011年4月至2013年3月的数据，提取诊断为“股骨颈骨折”（ICD10编码S72.0）或“转子间骨折”（S72.1）并接受“双极髋关节置换术”或“切开复位内固定术”的患者。共纳入110133例患者。使用多水平回归模型的横断面分析方法分析区域临床路径与术后住院时间之间的关联。
实施区域临床路径的医院，髋部骨折患者术后住院时间显著缩短（13天）。我们发现术后住院时间在不同医院之间存在16%的差异，这可能是由于医院层面实施区域临床路径所致。在患者层面应用区域临床路径使术后住院时间减少了4天。
无论是否在患者层面实施临床路径，在医院层面为髋部骨折患者实施区域临床路径都与术后住院时间缩短有关。这表明区域临床路径对医院的患者护理管理是有效的。
