Impact of Regional Clinical Pathways on the Length of Stay in Hospital Among Stroke Patients in Japan
Impact of Regional Clinical Pathways on the Length of Stay in Hospital Among Stroke Patients in Japan
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DOI：
10.1097/mlr.0000000000000146
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发表时间：
2014-07-01
期刊：
影响因子：
3
通讯作者：
Matsuda, Shinya
中科院分区：
文献类型：
--
作者：
Fujino, Yoshihisa;Kubo, Tatsuhiko;Matsuda, Shinya
背景：临床路径是卫生保健提供者用来描述具有特定医疗条件的患者护理的基本步骤的护理计划。在日本，区域临床路径的临床实施已经得到推广，2008年收费表中包括一项新的卒中区域提供者间护理计划费用。然而，尚无证据表明区域性临床途径对脑卒中的疗效。目的：我们研究区域临床路径与脑卒中患者住院时间的关系。我们还研究了不同医院之间卒中患者住院时间是否存在差异，如果存在差异，区域临床路径对这种差异的影响。研究设计：2011年4月至2012年3月，使用诊断程序组合数据库进行横断面分析。对象：共117,180例诊断为脑梗死的患者，ICD10编码为I63。测量方法：利用1011家医院内嵌套的2级个体结构，通过多层回归模型估计区域临床路径的使用与住院时间（LOS）的关联。这些模型添加了可能与LOS相关的患者层面因素和医院层面因素。结果：实施区域临床路径的医院的LOS （9.1 d）明显短于未实施区域临床路径的医院。医院间LOS差异的约12%可能由医院是否实施区域临床路径来解释。在个体水平应用区域性临床路径与个体水平的LOS降低7.2天有关。结论：这些发现表明，区域临床路径在改善脑卒中患者的管理和促进医院之间护理的一致性方面具有潜在的有效性。
Background:Clinical pathways are care plans used by health providers to describe essential steps in the care of patients with specific medical conditions. Clinical implementation of the regional clinical pathways in Japan has spread, and the 2008 fee schedule included a new regional inter-provider care planning fee for stroke. However, no evidence regarding the efficacy of the regional clinical pathways for stroke has appeared.Objectives:We examined the association of regional clinical pathways on the length of in-hospital stay in patients with stroke. We also examined whether a variation in the length of in-hospital stay for stroke patients between hospitals exists, and if so, the impact of regional clinical pathways on this variation.Research Design:Cross-sectional analysis using the Diagnosis Procedure Combination database for the period April 2011 to March of 2012.Subjects:A total of 117,180 patients with the diagnosis cerebral infarction, coded as I63 in ICD10.Measures:Associations of the use of a regional clinical pathway with the length of in-hospital stay (LOS) were estimated by multilevel regression models using a 2-level structure of individuals nested within the 1011 hospitals. The models added both patient-level factors and hospital-level factors that are potentially associated with LOS.Results:Hospitals administering a regional clinical pathway had a significantly shorter LOS (9.1 d) than hospitals that did not. Approximately 12% of the variation in LOS between hospitals is possibly explained by whether hospitals implement regional clinical pathways. Application of regional clinical pathways at the individual level is associated with a 7.2-day decrease in LOS at the individual level.Conclusions:These findings suggest that the regional clinical pathways are potentially effective in improving the management of stroke patients and in promoting the consistency of care between hospitals.