Effect on Completion of Clinical Pathway for Improving Clinical Indicator: Cases of Hospital Stay, Mortality Rate, and Comprehensive-Volume Ratio

Abstract

Many studies have analyzed the effects of clinical pathways, but most have considered only single diseases. The purpose of the present study was to exploratively analyze electronic medical records related to the use of clinical pathways, seeking trends that could usefully benefit clinical activity. From the data warehouse of University of Miyazaki Hospital, collected from April 2014 to March 2016, we retrospectively identified 6523 patients for whom a clinical pathway was applied. Other inclusion criteria were single hospitalization, the type of medical fee was comprehensive, and data were available so that all clinical indicators could be calculated. Two types of deviation from the clinical pathway were defined: cancellation (described in the clinical pathway but not implemented) and addition (not described in the clinical pathway but nevertheless implemented). If the code of International Classification of Diseases describing the clinical pathway differed from that describing where the medical resource was mostly spent, we considered this as indicating a complication. We compared principal clinical indicators (length of hospital stay, mortality rate, and comprehensive-volume ratio) by completion rate for the clinical pathway. Regardless of whether patients had complications, completing the clinical pathway was associated with a significant reduction in length of hospital stay. This finding indicated that length of hospital stay could be shortened if all medical treatments described in the clinical pathway were implemented. Our results demonstrated that it is possible to shorten the length of hospital stay by improving clinical pathways to include medical treatment for preventing complications.