Effectiveness of a clinical pathway for the diagnosis and treatment of dementia and for the education of families.
OBJECTIVE
Clinical pathways (CPs) are rarely used in the treatment of dementia. We established a CP for a series of medical practices (diagnosis, treatment, establishment of a care system, and caregiver education) for patients with dementia hospitalized for a three-week period, and evaluated its usefulness.


METHODS
The length of hospital stay and hospital costs were compared between 23 consecutive patients with dementia hospitalized and treated using a CP and 20 controls treated by conventional medical practice without using a CP in a special ward for dementia patients. In the CP group, at the time of discharge, primary caregivers, physicians, and nurses were given a questionnaire to obtain their comments about the impression of treatment with the CP.


RESULTS
The questionnaire survey indicated that the CP deepened the caregiver's understanding of the sequence of medical practices for the inpatient, the disorders of the inpatient, the treatment methods, and the methods for coping with the disorder. The CP was also useful for facilitating inpatient medical practice and promoting the establishment of a care system after discharge. The use of the CP significantly shortened the length of hospital stay and decreased hospital costs during hospitalization but increased the amount of work per day and made the medical staff feel that their freedom to choose medical procedures had been restricted.


CONCLUSIONS
The CP was useful for execution of inpatient medical practices for patients with dementia.
Kazui
Hiroaki
H
Psychiatry and Behavioral Science, Osaka University Graduate School of Medicine, Japan. kazui@psy.med.osaka-u.ac.jp
Hashimoto
Mamoru
M
Nakano
Yoko
Y
Matsumoto
Keiji
K
Yamamura
Shuhei
S
Nagaoka
Kentaro
K
Mori
Etsuro
E
Endo
Hidetoshi
H
Tokunaga
Hiromasa
H
Ikejiri
Yoshitaka
Y
Takeda
Masatoshi
M
D000368:Aged; D017028:Caregivers / Q000193:education*; D019091:Critical Pathways; D003704:Dementia / Q000175:diagnosis* / Q000628:therapy*; D005190:Family; D005260:Female; D006266:Health Education / Q000379:methods*; D017721:Hospital Costs; D006760:Hospitalization; D006801:Humans; D007564:Japan; D007902:Length of Stay; D008297:Male; D016896:Treatment Outcome