Critical Pathways and Feedback to Improve Quality. Abstract, Executive Summary211 and Final Report

摘要

Despite their use by the majority of American hospitals, few controlled research211u001estudies have assessed the effectiveness of 'critical pathways'. This study 211u001eevaluated the critical pathways developed at a large teaching hospitals for five 211u001ecommon surgical procedures: coronary artery bypass graft (CABG) surgery, total 211u001eknee replacement, colectomy, thoracic surgery and hysterectomy. A total of 6,796 211u001epatients underwent one of the procedures during the study. For most procedures, 211u001ecost-operative length of stay was already falling significantly during the period 211u001ebefore pathway implementation. Follwoing implementation, lengths of stay fell 211u001esignificantly for all the study procedures: 21% for total knee replacement; 9% 211u001efor CABG surgery; 7% for thoracic surgery; 5% for hysterectomy; and 3% for 211u001ecolectomy (all p<0.01). These reductions in length of stay were matched, however, 211u001eby the neighboring hospitals that did not have critical pathway the specific 211u001eefficiency intiatives. We conclude that critical pathways were associated with a 211u001eperiod of rapid reduction in post-operative length of stay for the five study 211u001eprocedures Secular trends at nearby hospitals, however, produced comparable 211u001ereductions, raising questions about the marginal effectiveness of critical 211u001epathways as a method to increase efficiency in a competitive environment.