title: Clinical care pathway for head and neck cancer: a valuable tool for decreasing resource utilization.
abstract: OBJECTIVE
  To evaluate the durability over time of the reduction of resource utilization after implementing a clinical care pathway (CCP) for head and neck cancer surgery.
  
  
  METHODS
  Cohort study.
  
  
  METHODS
  A tertiary care academic medical center.
  
  
  METHODS
  We studied control subjects from 1995 (pre-CCP) (n = 87), a cohort from July 1, 1996, through July 31, 1997 (the first year after CCP implementation) (n = 43), and a cohort from 1999 (n = 82) after major resection and tracheostomy for upper aerodigestive tract cancer.
  
  
  METHODS
  Starting July 1, 1996, all patients undergoing major resection for head and neck cancer were treated using a CCP, which delineates daily interventions and goals.
  
  
  METHODS
  Length of stay (LOS), readmission and complication rates, and hospital charges.
  
  
  RESULTS
  Median total LOS and LOS exclusive of the intensive care unit decreased in the first year and remained stable at 3 years (from 13.0 to 8.0 days and from 10.5 to 6.4 days, respectively). The intensive care unit LOS decreased across 3 years from 2.2 to 1.1 days (P=.001). Median total charges declined from 105,410 US dollars pre-CCP to 65,919 US dollars at 3 years. Incidence of postoperative pneumonia decreased from 12% to 1% (P=.02), and readmission rate decreased from 18% to 11% (P=.37) across 3 years.
  
  
  CONCLUSIONS
  The CCP for head and neck cancer maintained the improvement in LOS and charges seen in the first year of implementation and continues to decrease resource utilization while enhancing quality of care.
authors.affiliation: Department of Otorhinolaryngology-Head and Neck Surgery, 3400 Spruce St, 5 Ravdin, Philadelphia, PA 19104, USA. weberRa@uphs.upenn.edu
authors.forename: Kristin M
authors.initials: KM
authors.lastname: Gendron
authors.forename: Stephen Y
authors.initials: SY
authors.lastname: Lai
authors.forename: Gregory S
authors.initials: GS
authors.lastname: Weinstein
authors.forename: Ara A
authors.initials: AA
authors.lastname: Chalian
authors.forename: Julian M
authors.initials: JM
authors.lastname: Husbands
authors.forename: Patricia F
authors.initials: PF
authors.lastname: Wolf
authors.forename: Liesje
authors.initials: L
authors.lastname: DiDonato
authors.forename: Randal S
authors.initials: RS
authors.lastname: Weber
mesh_terms: D000368:Aged; D015331:Cohort Studies; D005260:Female; D006258:Head and Neck Neoplasms / Q000628:therapy*; D006295:Health Resources / Q000706:statistics & numerical data; D017722:Hospital Charges; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D010347:Patient Care Planning; D010359:Patient Readmission