Improvement of health outcomes after continued implementation of a clinical pathway for radical nephrectomy

The clinical pathway is an important tool for outcome management. We evalua ted the overall effects of the continued implementation of a clinical pathw ay for radical nephrectomy on the length of hospital stay, admission charge s, and the quality of medical care. The data obtained from the second-year implementation (group 3) of the clinical pathway were compared with the dat a from the first-year implementation (group 2) and the year preceding imple mentation (group 1). Thirty-seven consecutive patients with renal cell carc inoma underwent radical nephrectomy in group 1, 47 in group 2, and 55 in gr oup 3; all were enrolled in this study. The length of hospital stay, averag e admission charges, and 8 quality indicators were measured in these patien ts. We also evaluated the variances in the implementation of the clinical p athway. The mean length of stay decreased by 14.0% (P = 0.0048) in group 2, and by .15.8% (P = 0.0014) in group 3, when compared to group 1. The total admission charges significantly de creased by 19.0% (P = 0.001) in group 2 , and by 27.9% (P < 0.0001) in group 3, compared to the charges for group 1 . A continued decrease in charges for operation and anesthesia, laboratory, pharmacy, and others were found 2 years after implementation of the clinic al pathway. Among the 8 quality indicators, 2 were continuously improved in the second-year implementation of the clinical pathway, 2 were improved si gnificantly in the second-year implementation only, and 4 showed no signifi cant change at all. Variances from the clinical pathway decreased significa ntly after continued implementation. Continued implementation of the clinic al pathway for radical nephrectomy can improve a physician's practice conti nuously by decreasing the length of hospital stay, admission charges, and v ariances, and by improving quality. However, the improved results after imp lementation of the clinical pathway should be maintained carefully to assur e good health care.