Coronary artery bypass graft (CABG) surgery patients in a clinical pathway gained less in health-related quality of life as compared with patients who undergo CABG in a conventional-care plan.
OBJECTIVE
The aim of this study is to determine the difference between clinical pathway (CP) and conventional care in terms of health-related quality of life (HRQoL) domains, depression and anxiety, as well as to determine the relative contribution of CP towards an improved HRQoL after coronary artery bypass graft (CABG).


METHODS
A longitudinal quasi-experimental pre-test/post-test design was used to study and compare clinical outcome, HRQoL depression and anxiety for CP versus conventional-care patients after CABG. HRQoL was measured by using Sf-36, while depression and anxiety were measured by using hospital anxiety and depression scale. Length of stay and patient complications were derived from the hospital database.


RESULTS
We found that implementing a CP decreased hospital delay from 2.50 (+/-7.19) to 1.80 (+/-1.60), which was statistically significant P = 0.002. We also found that patients in the conventional-care plan improved more than patients in the CP in HRQoL. Outcomes in favour of patients in the conventional-care trajectory were based on the difference between small effect sizes (ES) (> or =0.20 <0.50) for pathway patients and moderate ES (> or =0.50 <0.80) for conventional-care patients, except for the domain of physical functioning and physical component summary, where the ES for conventional care was large (>0.80).


CONCLUSIONS
The aim of designing and implementing pathways is to decrease length of stay and costs, while maintaining quality of care and improving patient outcomes. Our findings suggest that these aims were not fulfilled in this CABG pathway. We recommend that when designing a CP, all patient-related characteristics, risk indicators, along with physiological status, be taken into consideration.
University Medical Center Groningen, Department of Health Sciences, Subdivision Care Sciences, University of Groningen, Groningen, the Netherlands.
Noha
N
El Baz
Berrie
B
Middel
Jitse P
JP
van Dijk
Piet W
PW
Boonstra
Sijmen A
SA
Reijneveld
D000368:Aged; D001007:Anxiety / Q000453:epidemiology / Q000517:prevention & control; D001026:Coronary Artery Bypass; D019091:Critical Pathways / Q000592:standards*; D003863:Depression / Q000453:epidemiology / Q000517:prevention & control; D005260:Female; D006801:Humans; D007902:Length of Stay; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D009426:Netherlands / Q000453:epidemiology; D017063:Outcome Assessment, Health Care; D010551:Personality; D011183:Postoperative Complications; D011788:Quality of Life / Q000523:psychology*