Does the use of clinical paths improve the efficiency and quality of care under the case payment system for inguinal herniorrhaphy or transurethral prostatectomy?
BACKGROUND
We evaluated the effects of implementing clinical paths for both inguinal herniorrhaphy (IH) and transurethral prostatectomy (TURP) on the efficiency and quality of medical care under the case payment system.


METHODS
Patients undergoing IH or TURP were treated using the guidelines for clinical paths under the case payment system (CPUCP). The results of treatment after implementation of CPUCP were compared with results for patients treated before implementation of CPUCP. We also compared results using eight quality indicators both before and after implementation of CPUCP.


RESULTS
The post-CPUCP length of hospital stay decreased significantly in patients who underwent either IH (p < 0.001) or TURP (p = 0.008). The post-CPUCP total admission charges decreased (p = 0.001) by 7.5% in the IH group alone. Two quality indicators in the IH group and three quality indicators in the TURP group were significantly improved after implementation of CPUCP. The percentage of patients who completed treatment without deviation as recommended by the guidelines for CPUCP was about 60% in the IH group and about 70% in the TURP group.


CONCLUSIONS
The results of this study indicate that the implementation of clinical paths under the case payment system for patients undergoing inguinal herniorrhaphy or transurethral prostatectomy can improve the efficiency and quality of medical care.
Chang
P L
PL
Department of Surgery, Chang Gung Memorial Hospital, Taipei, Taiwan, R.O.C. henryc@mail.tmc.edu.tw
Huang
S T
ST
Hsieh
M L
ML
Wang
T M
TM
Tsui
K H
KH
Lai
R H
RH
D019091:Critical Pathways; D006552:Hernia, Inguinal / Q000601:surgery*; D006801:Humans; D007902:Length of Stay; D008297:Male; D011468:Prostatectomy; D011787:Quality of Health Care