THE USE OF CLINICAL-PRACTICE GUIDELINES (CPGS) TO EVALUATE PRACTICE AND CONTROL COSTS IN VENTRICULOPERITONEAL SHUNT MANAGEMENT

BACKGROUND As a step toward maximizing the quality and cost-effectiven ess of neurosurgical care, we designed clinical practice guidelines (C PGs) for the management of VP shunt malfunctions and infections at a t ertiary care pediatric teaching institution, The detailed CPGs determi ne the use of radiographic studies, laboratory tests, and invasive pro cedures in the management of this problem, One purpose of the CPGs is to provide clear clinical guidelines for the medical trainee, thereby reducing variability in care and unnecessary utilization of resources. METHODS The CPGs were developed in stages over a 2-year period, The p ractice patterns in our institution for the management of shunt malfun ctions and infections were articulated, They were compared with those published in the neurosurgical literature, and areas of clinical decis ion-making variability were identified, Preliminary guidelines were fo rmulated, and data regarding patient care were prospectively collected , Based on this data, final CPGs were formulated and implemented, Tota l and itemized hospital charges for patients managed according to the CPGs were compared with those for patients in the 3 years before CPG i mplementation, RESULTS CPG-managed patients had generally lower total and itemized charges as compared with control patients, Decreased char ges per hospital day and charges for shunt films in the CPG group were statistically significant. CONCLUSIONS The process by which the CPGs were developed and implemented, as well as the CPGs themselves, are de scribed, We also present the clinical, demographic, and financial data that were prospectively collected for all patients managed within the CPGs over an initial I-year period and compare it with data obtained for control groups of shunt malfunction patients admitted during the 3 years before implementation of the CPGs. We find a trend toward reduc tion of charges after implementation of the CPG. (C) 1997 by Elsevier Science Inc.