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Impact on Cost and Quality of Care

Ehab Hanna, MD; Susan Schultz, HT(ASCP), DC, MHSA; Donnella Doctor, RN, MNSc; Emre Vural, MD; Scott Stern, MD; James Suen, MD

Arch Otolaryngol Head Neck Surg. 1999;125:1247-1251.

Background  The current health care climate demands the provision of quality patient care in a cost-effective manner. Clinical pathways define the essential components of care that are provided to patients with a specific diagnosis to achieve a desired outcome within a predetermined period. Development and implementation of clinical pathways streamline the provision of quality care in the most cost-effective manner.

Objectives  To develop a clinical pathway for patients undergoing total laryngectomy and to evaluate its impact on the cost and quality of care provided to these patients.

Setting  A tertiary care academic medical center.

Patients and Methods  A total of 45 patients were included in the study. The clinical pathway was implemented for 15 patients, while the other 30 patients were treated without the implementation of the pathway guidelines.

Main Outcome Measures  Length of hospital stay, readmission rate, and hospital variable costs.

Results  The clinical pathway affected all cost outcome measures. Length of stay decreased by 2.4 days (29%; P=.001), and the average hospital variable cost decreased from $3992 to $3419 per case. This represents a 14.4% reduction in cost associated with pathway implementation (P=.02). The standardization of care eliminated unnecessary variation and repetition in resource usage, resulting in overall cost reduction. Pathway implementation resulted in a lower readmission rate (7% [1/15]) than that of patients treated prior to protocol implementation (23% [7/30]).

Conclusion  Implementing a carefully developed clinical pathway may reduce cost without compromising the quality of care for patients undergoing total laryngectomy.

From the Departments of Otolaryngology–Head and Neck Surgery (Drs Hanna, Vural, and Suen), Administration (Ms Schultz), and Clinical Research (Ms Doctor), University of Arkansas for Medical Sciences, and the Baptist Memorial Medical System (Dr Stern), Little Rock, Ark.

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