Effectiveness of the clinical pathway in the management of congestive heart failure.
BACKGROUND
The prevalence of congestive heart failure (CHF) in the United States is approximately 4 million, with associated annual health care expenditures exceeding dollar 8 billion. Clinical pathways for CHF have been developed, but they have not been rigorously evaluated regarding efficacy and improvement in the quality of care. We sought to evaluate the effect of a CHF clinical pathway on hospital charges, length of stay, and use of angiotensin-converting enzyme (ACE) inhibitors in patients with CHF in a retrospective cohort study.


METHODS
We studied 371 patients (age range, 44-92 yr) with discharge diagnoses of CHF in a 376-bed community hospital between July 1996 and December 1997. We conducted chart reviews to determine length of stay, hospital charges, and use of ACE inhibitors.


RESULTS
Of the 371 patients, 174 were assigned to the clinical pathway and 197 were not. Baseline characteristics of the two groups were similar. The benchmark of less than 4 days' in-hospital stay was achieved in 65% of patients on the pathway and 42% who were not on the pathway (odds ratio, 2.6; 95% confidence interval, 1.67-4.05; P < 0.001). The median hospital charges were lower in the group on the clinical pathway (dollar 3,000 versus dollar 5,500, P < 0.001). In addition, 81% of the patients on the clinical pathway were administered ACE inhibitors, compared with 48% of equally eligible patients from the nonpathway group (odds ratio, 4.68; 95% confidence interval, 2.85-7.72; P < 0.001).


CONCLUSIONS
The clinical pathway for CHF was associated with increased use of ACE inhibitors as well as reduced length of stay and hospital charges.
Ranjan
Aparna
A
Greater Baltimore Medical Center, Baltimore, MD 21204, USA.
Tarigopula
Leena
L
Srivastava
Rakesh K
RK
Obasanjo
Olugbenga O
OO
Obah
Eugene
E
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000009:adverse effects / Q000191:economics / Q000627:therapeutic use*; D003363:Cost Control / Q000706:statistics & numerical data; D019091:Critical Pathways / Q000191:economics; D005260:Female; D006333:Heart Failure / Q000188:drug therapy* / Q000191:economics; D017722:Hospital Charges / Q000706:statistics & numerical data; D006764:Hospitals, Community / Q000191:economics; D006801:Humans; D007902:Length of Stay / Q000191:economics; D008297:Male; D008396:Maryland; D008875:Middle Aged; D011785:Quality Assurance, Health Care / Q000191:economics; D012189:Retrospective Studies; D016896:Treatment Outcome
D000806:Angiotensin-Converting Enzyme Inhibitors