The implementation of evidence-based, standardized clinical pathways may be an effective way of maintaining high-quality care at lower costs in pediatric care settings, results of a recent study show.
Clinical pathways are increasingly being utilized at institutions to improve outcomes and manage costs, but there have been few studies assessing their use in supporting the care provided to pediatric populations. Therefore, researchers from the University of Washington and Seattle Children’s Hospital conducted a retrospective study comparing outcomes, hospital efficiency, and cost of care associated with pediatric patients treated before and after the implementation of clinical pathways at Seattle Children’s Hospital.
Led by K Casey Lion, MD, MPH, the researchers developed and implemented pathways according to three principles: (1) treatment should be evidence-based when possible and otherwise should be consensus-based; (2) recommendations should be hard-wired into electronic order sets to encourage adherence; and (3) outcome measures must be owned and tracked by someone who is responsible for continuous improvement of the pathway.
Using this framework, 15 new pathways were developed over a 5-year period, from 2010 to 2014, with $17 million budgeted to support the initiative. Most of the budget was allocated to cover the roughly 1000 person-hours that were required to develop and implement the pathways.
A total of 3808 patients treated pre-pathway implementation and 2902 patients treated post-pathway implementation were identified for analysis in the study, with between 7 months and 45 months of data collected for the pre-pathways group and between 7 months and 44 months of data collected for the post-pathways group.
Prior to the implementation of the pathways, hospital costs per admission steadily rose at a rate of $126 per month. After pathways were implemented, this trend was halted, and costs decreased at a rate of $155 per month.
The length of stay (LOS) in the pre-pathway group remained relatively stable at a mean rate of 3.3 days. In the post-pathways group, LOS fell steadily at a rate of 0.03 days (45 minutes) per admission month, equating to a total reduction of 8.6 hours over the course of 1 year.
Using the Pediatric Quality of Life Inventory 4.0 Generic Core or Infant Scales, the researchers also assessed how patients’ overall physical functioning changed before and after the implementation of clinical pathways. After pathways were implemented, physical functioning scores increased at a rate of 0.5 points per month, or 6 points per year, far exceeding the minimal clinically important difference of 4.5 points per year.
From the results, the researchers determined that the implementation of clinical pathways helped to halt rising hospital costs, decrease LOS, and improve stable physical function scores.
They concluded that “a system of clinical pathways, integrating the best available evidence using a rigorous process, holds promise for meeting the challenges facing our health care system today: to enhance the value of care by decreasing costs and resource utilization while maintaining or improving patient-centered outcomes.”—Sean McGuire
