[MOL] Keeping Up With the latest..... [00898] Medicine On Line

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A study conducted at The University of Texas M. D. Anderson Cancer Center has found that the implementation of care pathways minimizes patient hospital stay and overall treatment costs without compromising quality of care – regardless of whether or not the patients on the study were placed on the care pathway.

Published in the March 1, 2000, issue of Archives of Otolaryngology - Head and Neck Surgery, the research assesses the impact of a specific clinical care pathway on the practice of head and neck oncologic surgery at M. D. Anderson, one of the country’s leading Comprehensive Cancer Centers.

A care pathway is a written multidisciplinary plan that describes the expected events and interventions in an episode of care. Necessitated by the growth of the managed care industry, pathways serve as guidelines for efficient use of medical resources, eliminating unnecessary tests and other treatment activities.

“This study is significant because it demonstrates that cost minimization can occur without sacrificing quality of care,” said Dr. Amy Chen, lead author and a fellow in Department of Head and Neck Oncologic Surgery at M. D. Anderson. “Development and implementation of the pathways benefit both the caregiver and the patient.”

In the cross-sectional research, Dr. Chen and her colleagues evaluated the overall treatment and care of 190 patients who had received a surgical neck dissection as a standard cancer therapy.

In the first group of patients, 96 received treatment from 1993 to 1994, prior to the institutional implementation of the care pathway. The group’s average length of hospital stay was four days. Overall treatment costs — including room, board and nursing costs — for individual patients were $8,459.

A second group studied consisted of 94 patients who received treatment from 1996 to 1998, after the care guidelines existed. In this group, 30 patients were managed on the pathway and 64 were not. The average length of stay in the hospital for patients in the second group was two days – 50 percent shorter than patients treated before the pathway.

Overall treatment costs for this second group were $6,885 for non-care pathway treated patients and $6,227 for care pathway patients.

“This study reaffirms that the benefits to patients and caregivers of care pathways if properly implemented,” said Dr. Helmuth Goepfert, chairman of the Department of Head and Neck Oncologic Surgery.

The quality of care received by the patients was measured by examining the possible adverse effects of the surgical procedure. Researchers found no difference in death rates or surgical complications among the groups.

According to Dr. Chen, the success of implementing care pathways at M. D. Anderson has involved a strong emphasis on patient education. Part of the pathway includes educating patients on how to care for themselves after the leaving the hospital. “Empowering the patient with knowledge about their disease and how to take an active role in the care process is essential to the success of care pathways,” she said.

“If patients know how to take care of their wounds after surgery, for example, then that will likely shorten their stay in the hospital. The success of care pathways is really the result of a cooperative effort between the patient and those administering the care.”

Since the institutional development of care pathways in 1995, M. D. Anderson has been at the forefront of implementing these guidelines into the practice of treating cancer. Last year, more than 6,000 M. D. Anderson patients were enrolled in one of the 70 existing collaborative care pathways at the institution. A patient is placed on pathways at his/her physician’s discretion.

“Our care pathways are designed to be patient focused,” explains Dr. Mitchell Morris, senior vice president and chief information officer at M. D. Anderson. “Our program allows for variations within pathways to ensure that all patients care needs are met. The ultimate responsibility we have as physicians is to provide the highest quality of care to our patients.”

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