title: The impact of clinical pathways on the practice of head and neck oncologic surgery: the University of Texas M. D. Anderson Cancer Center Experience.
abstract: OBJECTIVE
  To assess the impact of clinical pathways on the practice of head and neck oncologic surgery in an academic center.
  
  
  METHODS
  Cross-sectional study.
  
  
  METHODS
  Cancer treatment center.
  
  
  METHODS
  The study population consisted of 3 groups of patients who underwent unilateral neck dissection and were treated in the Department of Head and Neck Surgery of the University of Texas M. D. Anderson Cancer Center, Houston. Additional procedures which may have been performed were direct laryngoscopy, rigid esophagoscopy, and/or dental extractions. Ninety-six patients treated during 1993-1994 prior to the implementation of the clinical pathway (historical control group) were compared with 94 patients treated during 1996-1998, 64 who were not (contemporaneous nonpathway group) and 30 who were managed on the clinical pathway (pathway group). Patients from 1995 were excluded since the pathway was in the planning stages then.
  
  
  METHODS
  Median length of stay; median total costs of care.
  
  
  RESULTS
  The median length of hospital stay of the historical control, contemporaneous nonpathway, and pathway groups decreased from 4.0 to 2.0 days (P<.001). The total median costs of care were less in the pathway group as compared with the historical control group ($6,227 and $8,459, respectively, P<.001) and also less in the contemporaneous nonpathway group compared with the historical control group (S6885 and $8,459, respectively, P<.001). Mean and median length of hospital stay and costs were lower in the pathway group as compared with the nonpathway group but not significantly (P = .11 and P = .07, respectively) The contemporaneous nonpathway and pathway groups did not differ in complications or readmissions.
  
  
  CONCLUSIONS
  Development and implementation of this clinical pathway played a statistically significant role in decreasing length of hospital stay and total costs of care associated with neck dissection between nonpathway and pathway patients. Thus, a more cost-effective practice environment has resulted for all of our patients.
authors.affiliation: University of Texas M.D. Anderson Cancer Center, Department of Head and Neck Surgery, Houston 77030, USA.
authors.forename: A Y
authors.initials: AY
authors.lastname: Chen
authors.forename: D
authors.initials: D
authors.lastname: Callender
authors.forename: C
authors.initials: C
authors.lastname: Mansyur
authors.forename: K M
authors.initials: KM
authors.lastname: Reyna
authors.forename: E
authors.initials: E
authors.lastname: Limitone
authors.forename: H
authors.initials: H
authors.lastname: Goepfert
mesh_terms: D000046:Academic Medical Centers / Q000191:economics; D002173:Cancer Care Facilities / Q000191:economics; D003362:Cost-Benefit Analysis; D019091:Critical Pathways / Q000191:economics; D005260:Female; D006258:Head and Neck Neoplasms / Q000191:economics / Q000601:surgery*; D017721:Hospital Costs / Q000706:statistics & numerical data; D006801:Humans; D007902:Length of Stay / Q000191:economics; D008297:Male; D008875:Middle Aged; D037981:Neck Dissection / Q000191:economics; D013781:Texas