title: Clinical pathway for acute exacerbations of chronic obstructive pulmonary disease: method development and five years of experience.
abstract: BACKGROUND
  Randomized controlled trials, evidence-based medicine, clinical guidelines, and total quality management are some of the approaches used to render science-based health care services. The clinical pathway for hospitalized patients suffering from acute exacerbations of chronic obstructive pulmonary disease (AECOPD) is poorly established, although a clinical pathway is an integral part of total quality management.
  
  
  OBJECTIVE
  To evaluate the outcomes of patients hospitalized with AECOPD in Japan, treated with a clinical pathway following published guidelines.
  
  
  METHODS
  Prospective data were collected for patients with AECOPD admitted to a general hospital over a 5-year period since 2003. The clinical pathway was designed to establish general rules for the entire treatment protocol. The clinical pathway indicates which treatments and interventions should be performed, and when. In this study, health care providers were required to check the clinical pathway sheets to determine the next step of treatment.
  
  
  RESULTS
  This study analyzed 276 hospitalizations in 165 patients. The clinical pathway was interrupted and defined as a dropout in 45 cases (16.3%). Nine patients died during hospitalization (3.3%). Oxygen was administered in 232 hospitalizations (84.1%). Noninvasive positive pressure ventilation (NPPV) treatment was administered in 110 hospitalizations (39.9%). The rate of intubation in those cases where NPPV treatment had been administered was 8.2% (9 cases out of 110). The average length of stay (LOS) was 20.3 days, and the median value was 15 days. The LOS was longer than 30 days in 34 admissions (12.3%), mainly due to complications.
  
  
  CONCLUSIONS
  AECOPD can be managed using a clinical pathway. This clinical pathway could fill the gap between guidelines and clinical practice.
authors.affiliation: Department of Internal Medicine, Kaikoukai Jousai Hospital, Aichi, Japan. koichi-nishimura@nifty.com
authors.forename: Koichi
authors.initials: K
authors.lastname: Nishimura
authors.forename: Maya
authors.initials: M
authors.lastname: Yasui
authors.forename: Takashi
authors.initials: T
authors.lastname: Nishimura
authors.forename: Toru
authors.initials: T
authors.lastname: Oga
mesh_terms: D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001993:Bronchodilator Agents / Q000627:therapeutic use; D019091:Critical Pathways / Q000592:standards; D003661:Decision Support Techniques; D005260:Female; D017052:Hospital Mortality; D006769:Hospitals, General; D006801:Humans; D007297:Inpatients; D007442:Intubation, Intratracheal; D007564:Japan; D007902:Length of Stay; D008168:Lung / Q000503:physiopathology*; D008297:Male; D010043:Outcome and Process Assessment, Health Care; D010102:Oxygen Inhalation Therapy; D010352:Patient Dropouts; D011175:Positive-Pressure Respiration; D017410:Practice Guidelines as Topic; D016730:Program Development; D015397:Program Evaluation; D011446:Prospective Studies; D029424:Pulmonary Disease, Chronic Obstructive / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D012129:Respiratory Function Tests; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000305:Adrenal Cortex Hormones; D000900:Anti-Bacterial Agents; D001993:Bronchodilator Agents