title: Laparoscopy-assisted vaginal hysterectomy clinical pathway. A multivariate analysis of impact on costs and quality of care.
abstract: Numerous studies have demonstrated that a well-designed clinical pathway is an effective means of sustaining quality while controlling costs in the management of certain disease entities. We evaluated the impact that cost and medical quality have on the implementation of a clinical pathway for laparoscopy-assisted vaginal hysterectomy (LAVH). This retrospective study involved a sample of 124 patients who underwent LAVH in a medical center in central Taiwan. Patients were divided into two groups on the basis of whether they received treatment before or after implementation of the LAVH clinical pathway. The preclinical pathway group was comprised of 40 patients who underwent LAVH before clinical pathway implementation (May-December 1997). The clinical pathway group included 84 patients who underwent LAVH after implementation of the clinical pathway (January 1998-March 1999). In order to study the impact of the LAVH clinical pathway, patient characteristics were controlled by multiple linear regression. The results showed a significant reduction in cost, average length of hospital stay, and average duration of surgery and anesthesia (p < 0.01). Dependent nominal variables for clinical indicators like postoperative intravenous fluid and injection of antibiotics 48 h after surgery, and complications were analyzed by a logistic regression model. The results noted better control of antibiotic intravenous injection 48 h after surgery in the clinical pathway group (p = 0.03). The other indicators included delay of operation day, blood transfusion, patient mortality, and patients readmitted within 2 weeks. There was one operation day delay and one readmission within 2 weeks of discharge in the preclinical pathway group. Based on our results, the implementation of a clinical pathway for LAVH contains cost while maintaining quality of care, especially when the medical fees are paid under the case payment system.
authors.affiliation: Department of OBS/GYN, China Medical College Hospital, No. 2 Tuh-Der Road, Taichung 404, Taiwan. wei66@iris.seed.net.tw
authors.forename: Wei-Chun
authors.initials: WC
authors.lastname: Chang
authors.forename: Cheng-Chun
authors.initials: CC
authors.lastname: Lee
authors.forename: Hsi-Chin
authors.initials: HC
authors.lastname: Wu
authors.forename: Lian-Shung
authors.initials: LS
authors.lastname: Yeh
mesh_terms: D000328:Adult; D019091:Critical Pathways / Q000191:economics* / Q000592:standards*; D005260:Female; D017721:Hospital Costs; D006801:Humans; D007045:Hysterectomy, Vaginal / Q000191:economics / Q000379:methods* / Q000592:standards; D010535:Laparoscopy / Q000191:economics / Q000592:standards*; D007902:Length of Stay; D008499:Medical Records; D017063:Outcome Assessment, Health Care; D012189:Retrospective Studies; D013624:Taiwan; D002583:Uterine Cervical Neoplasms / Q000601:surgery; D014594:Uterine Neoplasms / Q000601:surgery*