title: Measuring quality and cost of care: evaluation of an amputation clinical pathway.
abstract: This study was based on nursing literature supporting the use of clinical pathways in case management systems to improve quality, reduce cost, and increase efficiency. Its purpose was to provide a descriptive analysis of outcomes in lower-extremity amputation caused by arterial occlusive disease. Patients were admitted between Jan. 1, 1989, and Sept. 1, 1995, with arterial occlusive disease for an above- or below-knee amputation and were cared for in three consecutive phases of nursing case management: (1) without a clinical pathway (group I), (2) with a consultation to rehabilitation services in the postoperative stay (group II), and (3) with a rehabilitation-focused clinical pathway (group III). The results of the study indicated more patients were able to return home from acute care and rehabilitation (52%) in group III than in group I and group II (40% and 44%, respectively). In addition, the hospital length of stay was reduced from 11 days to 8 days (geometric mean) once a rehabilitation consultation was included in the plan of care (group II). Although hospital charges rose initially with rehabilitation consultation ($18,627), they were reduced significantly when the pathway was used ($12,629; adjusted for rate increases). When patients were separated by level of amputation, those with below-knee amputations in group III had a significantly shorter length of stay and lower hospital charges than those in the other two groups, but comorbidity remained high. Nurse case managers can use this clinical pathway as a model for care as the findings support its cost effectiveness. They also demonstrate its effectiveness in enhancing the of quality care through a rehabilitation-focused, goal-oriented plan to return patients home.
authors.affiliation: Gundersen Lutheran Medical Center, LaCrosse, Wisc.
authors.forename: D E
authors.initials: DE
authors.lastname: Schaldach
mesh_terms: D000671:Amputation, Surgical / Q000191:economics / Q000451:nursing*; D019091:Critical Pathways; D005260:Female; D017722:Hospital Charges; D006780:Hospitals, Rural; D006801:Humans; D007866:Leg / Q000601:surgery; D007902:Length of Stay; D008297:Male; D017063:Outcome Assessment, Health Care; D011787:Quality of Health Care