USE OF CLINICAL PATHWAY TO IMPROVE PRACTICE PERFORMANCES IN PATIENTS UNDERGOING RADICAL NEPHRECTOMY

Abstract
This study used performance measurements to evaluate the influences of clinical pathway for radical nephrectomy in improving practice performance. From April 1997 to August 2001, patients with renal cell carcinoma were treated for radical nephrectomy using a clinical pathway. Patients were classified into five groups: 1) group 1: from April 1996 to March 1997, before clinical pathway implementation; 2) group 2: from April 1997 to March 1998; 3) group 3: from April 1998 to March 1999; 4) group 4: from May 1999 to June 2000; 5) group 5: from July 2000 to August 2001. This study compares 12 performance measurements, including length of hospital stay and admission charges, before and after the implementation of the clinical pathway for radical nephrectomy. The five groups did not differ significantly in terms of number of patients, mean patient age, and proportions of men and women. Eight of the twelve performance measurements improved significantly after one year of clinical pathway implementation. Moreover, the performance improvements were maintained continuously during the following three years of implementation of clinical pathway for radical nephrectomy. This study concludes that the implementation of clinical pathway for radical nephrectomy can improve practice performance, including management procedures, length of hospital stay, admission charges and outcomes.

Key words
Clinical pathway, performance measurement, radical nephrectomy

Bibliografía del artículo

1. Spath PL. Beyond clinical paths: advanced tools for outcomes management. American Hospital Publishing, Inc., Chicago, 1997.
2. Eisen SV, Dill DL, Grob MC. Reliability and validity of a brief patient-instrument for psychiatric outcome evaluation. Hospital and Community Psychiatry. 1994; 45:242-47.
3. Mannion R, Goddard M. Performance measurement and improvement in health care. Appl Health Econ Health Policy. 2002; 1(1):13-23.
4. Staker LV. Teaching performance improvement: an opportunity for continuing medical education. J Contin Educ Health Prof. 2003 Spring; 23 Suppl 1:S34-52.
5. Beitsch LM, Grigg CM, Mason K, Brooks RG. Profiles in courage: evaluation of Florida's quality improvement and performance measurement system. J Public Health Manag Pract. 2000; 6:31–41.
6. Keyes MA. CONQUEST 2.0: an emerging clinical performance measurement tool. J Healthc Qual. 2000; 22:29–36.
7. Chang PL, Lee SHH, Hsieh ML, Huang ST, Tsui KH, Lai RH. Improvement of practice performance in urological surgery via clinical pathway implementation. World J Urol. 2002; 20: 213–8.
8. Kmetik KS, Williams JR, Hammons T, Rosof BM. The American Medical Association and physician performance measurement: information for improving patient care. Tex Med. 2000; 96:80-3.
9. Nelson EC, Splaine ME, Godfrey MM, Kahn V, Hess A, Batalden P, Plume SK. Using data to improve medical practice by measuring processes and outcomes of care. Jt Comm J Qual Improv. 2000; 26:667–85.
10. Robson CJ. Radical nephrectomy for renal cell carcinoma. J Urol. 1963; 89:37-42.
11. Chang PL, Li YC, Lee SH. The differences in health outcomes between Web-based and paper-based implementation of a clinical pathway for redical nephrectomy. BJU Int. 2002; 90:522-8.
12. Chang PL, Wang TM, Huang ST, Hsieh ML, Chuang YC, Chang CH. Improvement of health outcomes after continued implementation of a clinical pathway for radical nephrectomy. World J Urol. 2000; 18:417-21.
13. Stark JF, Stark J. Performance measurement in congenital heart surgery: benefits and drawbacks. Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu. 2003; 6:171-83.
14. Boulet JR, Gimpel JR, Errichetti AM, Meoli FG. Using National Medical Care Survey data to validate examination content on a performance-based clinical skills assessment for osteopathic physicians. J Am Osteopath Assoc. 2003 May; 103(5):225-31
15. Gettman MT, Kondraske GV, Traxer O, Ogan K, Napper C, Jones DB, Pearle MS, Cadeddu JA. Assessment of basic human performance resources predicts operative performance of laparoscopic surgery. J Am Coll Surg. 2003 Sep; 197(3):489-96.
16. Spath PL. Clinical paths: tools for outcomes management. American Hospital Publishing, Inc, Chicago, Illinois, 1994.
17. Spath PL. Medical effectiveness and outcomes management: methods and case studies. American Hospital Publishing, Inc, Chicago, Illinois, 1996.
18. Ashton CM, Petersen NJ, Souchek J, Menke TJ, Yu HJ, Pietz K, Eigenbrodt ML, Barbour G, Kizer KW, Wray NP. Geographic variations in utilization rates in veterans affairs hospital and clinics. N Engl J Med. 1999; 340: 32-9.
19. Heller RF, O'Connell RL, Lim LLY, Atallah A, Lanas F, Joshi P, Tatsanavivat P. Variation in stated management of acute myocardial infarction in five countries. Int J Cardiol. 1999; 68: 63-7.
20. Wildschut HIJ, Hoope-Bender PT, Borkent-Polet M, Traas H, Van Agt HME, De Kroon MLA, Van Der Maas PJ. Practice variation of test procedures reportedly used in routine antenatal care in The Netherlands. Acta Obstet Gynecol Scandd. 1999; 78: 27-32.
21. Fennerty MB, Lieberman DA, Vakil N, Magaret N, Faigel DO, Helfand M. Effectiveness of Helicobacter Pylori therapies in a clinical practice setting. Arch Intern Med. 1999; 159: 1562-6.
22. Franks P, Zwanziger J, Mooney C, Sorbero M. Variations in primary care physician referral rates. Health Serv Res. 1999; 34: 323-9.

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