Cost Effectiveness of an Updated Clinical Pathway for Acute Nonvariceal Upper Gastrointestinal Bleeding

• Main Authors: Teng-Yu Lee, 李騰裕
• Other Authors: Tam Chan
• Format: Others
• Language: en_US
• Published: 2007
• Online Access: http://ndltd.ncl.edu.tw/handle/30015451404307421827

碩士 === 東海大學 === 工業工程與經營資訊學系 === 95 === Acute nonvariceal upper gastrointestinal (UGI) bleeding is a common medical emergency encountered by primary physicians that causes high costs, but there still is little evidence to prove the cost effectiveness of a clinical care pathway. We introduce the physician reminder system into an updated clinical pathway to improve physicians' adherence and hope there is significant impact on outcomes. The updated evidence-based clinical care pathway was designed and implemented in the general internal medicine wards, and used the physician reminder system that included chief residents as major reminders, checklists, and case review meetings. Use of medicine for acid suppression, length of stay (LOS), and variable costs including medicine, diagnostic tests were compared between patients before and after implementation of the clinical pathway. Quality of care was monitored by the rate of recurrent bleeding during hospitalization, rate of repeated UGI endoscopy, and rate of readmission due to recurrent bleeding within 30 days after discharge. This clinical pathway significantly reduced the use of intravenous medicine for acid suppression from 88% to 34%, with mean LOS per patient down from 6.7 to 3.6 days, mean cost of medicine per patient down from NTD 8768 to NTD 3940 (cost down 55.1%), mean cost of diagnostic tests per patient down from NTD 12560 to NTD 9493 (cost down 24.4%), and mean total hospital cost per patient down from NTD 33142 to NTD 19519 (cost down 41.1%). The indicators for quality of care were not significantly different. In conclusion, the clinical care pathway is a cost-effective method in management of acute nonvariceal UGI bleeding, and the physician reminder system may improve the compliance of primary physicians throughout clinical practice making the clinical pathway successful.