Effectiveness of the clinical pathway in the management of congestive heart failure
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...
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Published in | Southern medical journal (Birmingham, Ala.) Vol. 96; no. 7; pp. 661 - 663 |
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Main Authors | , , , , |
Format | Journal Article |
Language | English |
Published |
Hagerstown, MD
Lippincott Williams & Wilkins
01.07.2003
Southern Medical Association |
Subjects | |
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Abstract | 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. |
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AbstractList | BACKGROUNDThe 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.METHODSWe 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.RESULTSOf 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).CONCLUSIONThe clinical pathway for CHF was associated with increased use of ACE inhibitors as well as reduced length of stay and hospital charges. 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. |
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Author | SRIVASTAVA, Rakesh K OBASANJO, Olugbenga O OBAH, Eugene TARIGOPULA, Leena RANJAN, Aparna |
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Snippet | The prevalence of congestive heart failure (CHF) in the United States is approximately 4 million, with associated annual health care expenditures exceeding... BACKGROUNDThe prevalence of congestive heart failure (CHF) in the United States is approximately 4 million, with associated annual health care expenditures... |
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SubjectTerms | 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 |
Title | Effectiveness of the clinical pathway in the management of congestive heart failure |
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