Uloga kliničkih puteva u unapređenju kvaliteta liječenja u bolnicama zdravstvene zaštite u bolnicama za pacijente kojima je ugrađen vještački kuk

  • Savka Štrbac Institut za javno zdravstvo Republike Srpske
  • Severin Rakić
  • Vesna Vujić Aleksić
  • Ranko Škrbić

Sažetak


Background: Clinical pathways are important tools to achieve better quality of care and to reduce the costs for healthcare system. The total hip replacement (THR) is among the most expensive procedures in health system and the number of these operations has greatly increased in the past decade in the Republic of Srpska.

Aim: The aim of the present study was to determine how the implementation of a clinical pathway for THR can influence the length of stay and postoperative complications in hospitals in the Republic of Srpska.

Methods: This prospective and comparative study was performed on 2,485 patients who underwent the THR over a 3-year-period in 2012 (prior to the introduction of the clinical pathways, baseline), in 2013 (first evaluation period) and in 2014 (second evaluation period), one and two years after its implementation, respectively. The study was conducted in 10 hospitals in the Republic of Srpska, where the effects of the clinical pathways on length of stay and postoperative complications after THR were measured.

Results: The introduction of THR clinical pathways significantly decreased the length of stay in hospital from 14.53 ± 7.03 days measured at baseline, to 12.79 ± 4.81 days and 11.19 ± 4.11 days at first and second evaluation period, respectively. At the same time, the number of early postoperative complications such as death and venous thromboembolism significantly decreased in both groups, while the number of dislocations, as parameter of late complications, decreased just after the second evaluation period. For all other complications, such as revision procedures, infections and periprosthetic fracture, there were no statistical differences after the implementation of clinical pathways.

Conclusion: The introduction of clinical pathways was successful in reducing the length of stay in hospitals as well as the postoperative complications after THR.

Reference

1. King LK, March L, Anandacoomarasamy A. Obesity & osteoarthritis. Indian J Med Res 2013;138(2):185‐93.
2. Singh JA, Yu S, Chen L, Cleveland JD. Rates of total joint replacement in the United States: Future projections to 2020–2040 using the national inpatient sample. J Rheumatol 2019;46(9):1134‐40.
3. Barbieri A, Vanhaecht K, Van Herck P, Sermeus W, Faggiano F, Marchisio S, et al. Effects of clinical pathways in the joint replacement: A meta-analysis. BMC Med 2009;7:1–11.
4. Garson L, Schwarzkopf R, Vakharia S, Alexander B, Stead S, Cannesson M, et al. Implementation of a total joint replacement-focused perioperative surgical home: a management case report. Anesth Analg 2014;118(5):1081‐9.
5. Rotter T, Kinsman L, James E, Machotta A, Willis J, Snow P, et al. The effects of clinical pathways on professional practice, patient outcomes, length of stay, and hospital costs: Cochrane systematic review and meta-analysis. Eval Health Prof. 2012;35(1):3‐27.
6. Asmirajanti M, Syuhaimie Hamid AY, Hariyati TS. Clinical care pathway strengthens interprofessional collaboration and quality of health service: a literature review. Enferm Clin 2018; 28 Suppl 1:240‐4.
7. Svenøy S, Watne LO, Hestnes I, Westberg M, Madsen JE, Frihagen F. Results after introduction of a hip fracture care pathway: comparison with usual care. Acta Orthop 2020;91(2):139‐45.
8. Scaria M.K. Role of care pathways in interprofessional teamwork. Nurs Stand 2016; 24;30(52):42-7.
9. Lawal AK, Groot G, Goodridge D, Scott S, Kinsman L. Development of a program theory for clinical pathways in hospitals: protocol for a realist review. Syst Rev 2019; 8(1):136. doi: 10.1186/s13643-019-1046-0
10. Vanhaecht K, Sermeus W, Tuerlinckx G, Witters I, Vandenneucker H, Bellemans J. Development of a clinical pathway for total knee arthroplasty and the effect on length of stay and in-hospital functional outcome. Acta Orthop Belg 2005;71:439-44.
11. Kalmet PH, Koc BB, Hemmes B, Ten Broeke RH, Dekkers G, Hustinx P, et al. Effectiveness of a multidisciplinary clinical pathway for elderly patients with hip fracture: A multicenter comparative cohort study. Geriatr Orthop Surg Rehabil 2016;7(2):81‐5.
12. Featherall J, Brigati DP, Faour M, Messner W, Higuera CA. Implementation of a total hip arthroplasty care pathway at a high-volume health system: effect on length of stay, discharge disposition, and 90-day complications. J Arthroplasty 2018;33(6):1675‐80.
13. Ravi B, Jenkinson R, Austin Peter C, Croxford R, Wasserstein D, Escott B, et al. Relation between surgeon volume and risk of complications after total hip arthroplasty: propensity score matched cohort study. BMJ 2014; 348:g 3284. doi: 10.1136/bmj.g3284
14. Komić J, Bokonjić D, Rančić N. [Selected methods of statistical analysis for biomedical research]. Banja Luka: University of Banja Luka Faculty of Medicine; 2018. Serbian.
15. Schwarzkopf R, Zamansani T, Houng M, Bridgeman T. The effect of a clinical pathway strategy for managing care in total joint replacement: The impact on perioperative outcomes. J Clin Exp Orthop 2016;2:11. doi: 10.4172/2471-8416.100011
16. Mauerhan DR, Lonergan RP, Mokris JG, Kiebzak GM. Relationship between length of stay and dislocation rate after total hip arthroplasty. J Arthroplasty 2003; 18(8):963‐7.
17. Mufarrih SH, Ghani MOA, Martins RS, Qureshi NQ, Mufarrih SA, Malik AT, et al. Effect of hospital volume on outcomes of total hip arthroplasty: a systematic review and meta-analysis. J Orthop Surg Res 2019;14(1):468. doi: 10.1186/s13018-019-1531-0
18. Koenig KM, Bozic KJ. Orthopaedic Healthcare Worldwide: The role of standardization in improving outcomes. Clin Orthop Relat Res 2015; 473:3360–3.
19. Krummenauer F, Guenther KP, Kirschner S. Cost effectiveness of total knee arthroplasty from a health care providers' perspective before and after introduction of an interdisciplinary clinical pathway--is investment always improvement?. BMC Health Serv Res. 201;11:338. doi: 10.1186/1472-6963-11-338.
Objavljeno
2020/06/30
Broj časopisa
Rubrika
Originalni naučni članak