Effectiveness of regional clinical pathways on postoperative length of stay for hip fracture patients: A retrospective observational study using the Japanese Diagnosis Procedure Combination database
Effectiveness of regional clinical pathways on postoperative length of stay for hip fracture patients: A retrospective observational study using the Japanese Diagnosis Procedure Combination database
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DOI：
10.1016/j.jos.2019.02.002
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发表时间：
2020-01-01
影响因子：
1.7
通讯作者：
Matsuda, Shinya
中科院分区：
文献类型：
--
作者：
Mine, Yuko;Fujino, Yoshihisa;Matsuda, Shinya
背景资料：区域临床路径是一种新型的临床路径，其目的是通过区域内多个医疗机构之间的合作，实现医疗服务的规范化和优化化。然而，目前对髋部骨折（需要住院接受骨科手术的主要健康问题）区域临床路径的有效性评估不足。本研究旨在确定区域临床路径与髋部骨折患者术后住院时间（LOS）之间的关系。特别是，我们关注了医院之间髋部骨折患者术后LOS的变化以及区域临床路径对这种变化的贡献。方法：使用2011年4月至2013年3月日本诊断程序组合（DPC）数据库的数据，诊断为“股骨头颈骨折”的患者（ICD 10代码S72.0）或“经转子骨折”（S72.1）并接受“双极髋关节置换术”或“切开复位内固定”。共纳入110，133例患者。区域临床路径和术后LOS之间的关联进行了分析，采用横断面分析与多水平回归models.Results：医院实施了区域临床路径显示出显着减少（13天）在髋部骨折患者术后LOS。我们发现术后LOS的医院间差异为16%，这可能是由于医院层面实施区域临床路径所致。区域临床路径在患者水平的应用导致术后LOS.Conclusions的4天减少：区域临床路径髋部骨折患者在医院水平的实施与术后LOS减少，无论是否在患者水平的路径实施。这表明，区域临床路径是有效的病人护理管理在医院。(C)2019年日本骨科协会。Elsevier B.V.出版，保留所有权利。
Background: Regional clinical pathways, a new type of clinical pathway, are practiced with the aim of standardizing and optimizing medical care by cooperation among multiple medical institutions in a region. However, current evaluation of the effectiveness of regional clinical pathways for hip fracture, a major health problem requiring hospitalization for orthopedic surgery, is insufficient. This study aimed to determine the association between regional clinical pathways and postoperative hospital length of stay (LOS) among hip fracture patients. In particular, we focused on the variation in postoperative LOS of hip fracture patients among hospitals and the contribution of regional clinical pathways to this variation.Methods: Using data from the Diagnosis Procedure Combination (DPC) database in Japan from April 2011 to March 2013, patients who were diagnosed with "fracture of head and neck of femur" (ICD10 code S72.0) or "pertrochanteric fracture" (S72.1) and received "bipolar hip arthroplasty" or "open reduction and internal fixation" were extracted. A total of 110,133 patients were included. Associations between regional clinical pathways and postoperative LOS were analyzed using cross-sectional analysis with multilevel regression models.Results: Hospitals that implemented a regional clinical pathway showed a significant reduction (13 days) in the postoperative LOS of hip fracture patients. We found a 16% inter-hospital variation in postoperative LOS, which might be explained by hospital-level implementation of regional clinical pathways. Application of regional clinical pathways at the patient level resulted in a 4-day decrease in postoperative LOS.Conclusions: Implementation of regional clinical pathways for hip fracture patients at the hospital level was associated with reduced postoperative LOS, regardless of whether or not pathways were implemented at the patient level. This suggests that regional clinical pathways are effective for patient care management in hospitals. (C) 2019 The Japanese Orthopaedic Association. Published by Elsevier B.V. All rights reserved.