title: Development and implementation of a clinical pathway for patients undergoing total laryngectomy: impact on cost and quality of care.
abstract: BACKGROUND
  The current health care climate demands the provision of quality patient care in a cost-effective manner. Clinical pathways define the essential components of care that are provided to patients with a specific diagnosis to achieve a desired outcome within a predetermined period. Development and implementation of clinical pathways streamline the provision of quality care in the most cost-effective manner.
  
  
  OBJECTIVE
  To develop a clinical pathway for patients undergoing total laryngectomy and to evaluate its impact on the cost and quality of care provided to these patients.
  
  
  METHODS
  A tertiary care academic medical center.
  
  
  METHODS
  A total of 45 patients were included in the study. The clinical pathway was implemented for 15 patients, while the other 30 patients were treated without the implementation of the pathway guidelines.
  
  
  METHODS
  Length of hospital stay, readmission rate, and hospital variable costs.
  
  
  RESULTS
  The clinical pathway affected all cost outcome measures. Length of stay decreased by 2.4 days (29%; P=.001), and the average hospital variable cost decreased from $3992 to $3419 per case. This represents a 14.4% reduction in cost associated with pathway implementation (P=.02). The standardization of care eliminated unnecessary variation and repetition in resource usage, resulting in overall cost reduction. Pathway implementation resulted in a lower readmission rate (7% [1/15]) than that of patients treated prior to protocol implementation (23% [7/30]).
  
  
  CONCLUSIONS
  Implementing a carefully developed clinical pathway may reduce cost without compromising the quality of care for patients undergoing total laryngectomy.
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, University of Arkansas for Medical Sciences, Little Rock 72205-7199, USA.
authors.forename: E
authors.initials: E
authors.lastname: Hanna
authors.forename: S
authors.initials: S
authors.lastname: Schultz
authors.forename: D
authors.initials: D
authors.lastname: Doctor
authors.forename: E
authors.initials: E
authors.lastname: Vural
authors.forename: S
authors.initials: S
authors.lastname: Stern
authors.forename: J
authors.initials: J
authors.lastname: Suen
mesh_terms: D003363:Cost Control; D017046:Cost Savings; D003362:Cost-Benefit Analysis; D019091:Critical Pathways / Q000191:economics / Q000458:organization & administration* / Q000592:standards; D017048:Health Care Costs; D017721:Hospital Costs; D006801:Humans; D007825:Laryngectomy / Q000009:adverse effects / Q000191:economics* / Q000592:standards; D007902:Length of Stay; D008197:Lymph Node Excision / Q000191:economics / Q000592:standards; D017063:Outcome Assessment, Health Care / Q000191:economics; D010359:Patient Readmission; D011183:Postoperative Complications / Q000191:economics; D011446:Prospective Studies; D011787:Quality of Health Care; D012189:Retrospective Studies; D016896:Treatment Outcome