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Clinical Care Pathway for Head and Neck Cancer
A Valuable Tool for Decreasing Resource Utilization
Kristin M. Gendron, MD;
Stephen Y. Lai, MD, PhD;
Gregory S. Weinstein, MD;
Ara A. Chalian, MD;
Julian M. Husbands, MD;
Patricia F. Wolf, BS;
Liesje DiDonato, BS;
Randal S. Weber, MD
Arch Otolaryngol Head Neck Surg. 2002;128:258-262.
Objective To evaluate the durability over time of the reduction of resource utilization
after implementing a clinical care pathway (CCP) for head and neck cancer
surgery.
Design Cohort study.
Setting A tertiary care academic medical center.
Patients We studied control subjects from 1995 (pre-CCP) (n = 87), a cohort from
July 1, 1996, through July 31, 1997 (the first year after CCP implementation)
(n = 43), and a cohort from 1999 (n = 82) after major resection and tracheostomy
for upper aerodigestive tract cancer.
Interventions Starting July 1, 1996, all patients undergoing major resection for head
and neck cancer were treated using a CCP, which delineates daily interventions
and goals.
Main Outcome Measures Length of stay (LOS), readmission and complication rates, and hospital
charges.
Results Median total LOS and LOS exclusive of the intensive care unit decreased
in the first year and remained stable at 3 years (from 13.0 to 8.0 days and
from 10.5 to 6.4 days, respectively). The intensive care unit LOS decreased
across 3 years from 2.2 to 1.1 days (P= .001). Median total charges
declined from $105 410 pre-CCP to $65 919 at 3 years. Incidence
of postoperative pneumonia decreased from 12% to 1% (P= .02),
and readmission rate decreased from 18% to 11% (P= .37) across
3 years.
Conclusions The CCP for head and neck cancer maintained the improvement in LOS and
charges seen in the first year of implementation and continues to decrease
resource utilization while enhancing quality of care.
From the Departments of Otorhinolaryngology–Head and Neck Surgery
(Drs Gendron, Lai, Weinstein, Chalian, and Weber and Mss Wolf and DiDonato)
and Surgery (Dr Husbands), University of Pennsylvania Health System, Philadelphia.
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