Effectiveness of the clinical pathway in the management of congestive heart failure

• Published in: Southern medical journal (Birmingham, Ala.) Vol. 96; no. 7; pp. 661 - 663
• Main Authors: RANJAN, Aparna, TARIGOPULA, Leena, SRIVASTAVA, Rakesh K, OBASANJO, Olugbenga O, OBAH, Eugene
• Format: Journal Article
• Language: English
• Published: Hagerstown, MD Lippincott Williams & Wilkins 01.07.2003; Southern Medical Association
• Subjects: Adult; Aged; Aged, 80 and over; Angiotensin-Converting Enzyme Inhibitors - adverse effects; Angiotensin-Converting Enzyme Inhibitors - economics; Angiotensin-Converting Enzyme Inhibitors - therapeutic use; Biological and medical sciences; Cardiology. Vascular system; Care and treatment; Case studies; Congestive heart failure; Cost Control - statistics & numerical data; Critical Pathways - economics; Economic aspects; Female; Heart; Heart Failure - drug therapy; Heart Failure - economics; Heart failure, cardiogenic pulmonary edema, cardiac enlargement; Hospital Charges - statistics & numerical data; Hospitals, Community - economics; Humans; Length of Stay - economics; Male; Maryland; Medical research; Medical sciences; Medicine, Experimental; Middle Aged; Quality Assurance, Health Care - economics; Retrospective Studies; Treatment Outcome; Maryland; United States; Heart failure; Cardiovascular disease; Clinical management; Efficiency; Heart disease
• ISSN: 0038-4348; 1541-8243
• DOI: 10.1097/01.SMJ.0000060581.77206.ED

The prevalence of congestive heart failure (CHF) in the United States is approximately 4 million, with associated annual health care expenditures exceeding dollar 8 billion. Clinical pathways for CHF have been developed, but they have not been rigorously evaluated regarding efficacy and improvement in the quality of care. We sought to evaluate the effect of a CHF clinical pathway on hospital charges, length of stay, and use of angiotensin-converting enzyme (ACE) inhibitors in patients with CHF in a retrospective cohort study. We studied 371 patients (age range, 44-92 yr) with discharge diagnoses of CHF in a 376-bed community hospital between July 1996 and December 1997. We conducted chart reviews to determine length of stay, hospital charges, and use of ACE inhibitors. Of the 371 patients, 174 were assigned to the clinical pathway and 197 were not. Baseline characteristics of the two groups were similar. The benchmark of less than 4 days' in-hospital stay was achieved in 65% of patients on the pathway and 42% who were not on the pathway (odds ratio, 2.6; 95% confidence interval, 1.67-4.05; P < 0.001). The median hospital charges were lower in the group on the clinical pathway (dollar 3,000 versus dollar 5,500, P < 0.001). In addition, 81% of the patients on the clinical pathway were administered ACE inhibitors, compared with 48% of equally eligible patients from the nonpathway group (odds ratio, 4.68; 95% confidence interval, 2.85-7.72; P < 0.001). The clinical pathway for CHF was associated with increased use of ACE inhibitors as well as reduced length of stay and hospital charges.