THE EFFECTS OF A PRACTICE GUIDELINE ON ENDOSCOPIC SINUS SURGERY AT ANACADEMIC CENTER

Practice guidelines (PG) (or clinical pathways) are increasingly impor tant tools for standardizing health care delivery, improving efficienc y, monitoring quality, and controlling costs. Health services research ers divide the delivery of health care into three stages: structure, p rocess, and outcome. PGs are a technique to standardize the process of health care delivery, which may result in improved clinical outcomes or may maintain clinical outcomes while increasing process efficiency and decreasing costs. We describe the development and implementation o f a PG for endoscopic sinus surgery at an academic center, and report preliminary results on the effects of the PG on the health care proces s. The PG was developed using a multidisciplinary combination of conse nsus-building and evidence-based techniques. Initially, participation in the PG was voluntary and at the attending physician's discretion. O ne year after implementation of the PG, 41 patients had been enrolled by members of the medical school's full-time faculty. Process and shor t-term outcome variables on those patients were compared to a random s ample of 50 patients treated by the same physicians, but not using the PG. There was no evidence of selection bias into the PG based on demo graphics, severity of sinusitis, or the presence of comorbid factors. There were no differences in time spent in the operating room, postane sthesia care unit, or day surgery observation unit, between patients u sing the PG and not using the PG. However, patients not using the PG h ad a significantly higher rate of unplanned admission. Patients using the PG had significantly lower median hospital costs and charges than did patients not using the PG. In addition, median hospital costs and charges decreased steadily for all patients (not just those using the PG), simultaneous with the development and implementation of the PG. T here were no differences in short-term clinical outcomes between PG an d non-PG patients. In summary, the development and implementation of a PG for endoscopic sinus surgery resulted in lower hospital costs and charges while maintaining acceptable short-term clinical outcomes. PGs have important implications for improving the efficiency of the healt h care process.