Quality Improvement in Health Care (한국의료질향상학회지)

Korean Society for Quality in Health Care (한국의료질향상학회)
권호 표지
DOI QR코드

DOI QR Code

Effectiveness of a Clinical Pathway for Breast Cancer Patients Undergoing Surgical Operation on Clinical Outcomes and Costs

  • Jeong Hyun Park (Department of Clinical Research Design & Evaluation, SAIHST, Sungkyunkwan University) ;
  • Danbee Kang (Department of Clinical Research Design & Evaluation, SAIHST, Sungkyunkwan University) ;
  • Seok Jin Nam (Division of Breast Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Jeong Eon Lee (Division of Breast Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Seok Won Kim (Division of Breast Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Jonghan Yu (Division of Breast Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Byung Joo Chae (Division of Breast Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Se Kyung Lee (Division of Breast Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Jai Min Ryu (Division of Breast Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Yeon Hee Park (Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Mangyeong Lee (Department of Digital Health, SAIHST, Sungkyunkwan University) ;
  • Juhee Cho (Department of Clinical Research Design & Evaluation, SAIHST, Sungkyunkwan University)
  • Received : 2024.04.30
  • Accepted : 2024.06.07
  • Published : 2024.06.30
Download PDF
⟨ Previous Next ⟩

Abstract

Purpose: This study aimed to evaluate the impact of implementing a clinical pathways (CPs) on the clinical outcomes and costs of patients undergoing breast cancer surgery. Methods: This retrospective cohort study included patients who were newly diagnosed with primary breast cancer at the Samsung Medical Center between 2014 and 2019 (N=8482; 2931 patients in the pre-path and 5551 patients in the post-path). Clinical outcomes included reoperation during hospitalization, readmission, and emergency room visits within 30 days of discharge. The cost data for each unit were obtained from an activity-based management accounting system. We performed an interrupted time series analysis. Results: The post-path period showed a significantly shorter hospital length of stay (LOS) than the pre-path period (6.3 days in pre-path vs. 5.0 days in post-path; -1.3 days' difference; p=.001), and fewer reoperations during hospitalization and within 30 days after discharge than the pre-path period. After adjusting for inflation rates and relative value scores, the model demonstrated savings of $146 per patient in the post-path for total costs, and $537 per patient for patient out-of-pocket costs (p=.001). Conclusion: CPs can help reduce costs without compromising the quality of care by reducing the number of reoperations, readmissions, and complications.

Keywords

References

  1. Kang R, Goodney PP, Wong SL. Importance of cost-effectiveness and value in cancer care and healthcare policy. Journal of Surgical Oncology. 2016;114(3):275-80. 
  2. Lee KS, Chang HS, Lee SM, Park EC. Economic Burden of Cancer in Korea during 2000-2010. Cancer Research and Treatment.2015;47(3):387-98. 
  3. Park JH, Lee SK, Lee JE, Kim SW, Nam SJ, Kim JY, et al, Breast cancer epidemiology of the working-age female population reveals significant implications for the South Korean economy. Journal of Breast Cancer. 2018;21(1):91-5. 
  4. Kwon H, Lee JH, Woo J, Lim W, Moon BI, Paik NS. Efficacy of a clinical pathway for patients with thyroid cancer. Head & Neck 2018;40(9):1909-16. 
  5. Campbell H, Hotchkiss R, Bradshaw N, Porteous M. Integrated care pathways. British Medical Journal. 1998;316(7125):133-7. 
  6. Neubauer MA, Hoverman JR, Kolodziej M, Reisman L, Gruschkus SK, Hoang S, et al. Cost effectiveness of evidence-based treatment guidelines for the treatment of non-small-cell lung cancer in the community setting. Journal of Oncology Practice.2010;6(1):12-8. 
  7. Zon RT, Frame JN, Neuss MN, Page RD, Wollins DS, Stranne S, et al. American society of clinical oncology policy statement on clinical pathways in oncology. Journal of Oncology Practice. 2016;12(3):261-6. 
  8. Gautam S, Sylwestrzak G, Barron J, Chen X, Eleff M, Debono D, et al. Results from a health insurer's clinical pathway program in breast cancer. Journal of Oncology Practice. 2018;14(11):e711-21. 
  9. Malin JL. Charting the Course: Charting the course: Use of clinical pathways to improve value in cancer care. Journal of Clinical Oncology.2020;38(4):367-71. 
  10. Hudson J, Fielding S, Ramsay CR. Methodology and reporting characteristics of studies using interrupted time series design in healthcare. BMC Medical Research Methodology. 2019;19(1). 
  11. Ong WL, Schouwenburg MG, Van Bommel AC, Stowell C, Allison KH, Benn KE, et al. A standard set of value-based patient-centered outcomes for breast cancer: the International consortium for health outcomes measurement (ICHOM) initiative. The Journal of the American Medical Association Oncology 2017;3(5):677-85. 
  12. Vitug AF, Newman LA. Complications in breast surgery. Surgical Clinics of North Americ. 2007;87(2):431-51. 
  13. Panhofer P, Ferenc V, Schutz M, Gleiss A, Dubsky P, Jakesz R, et al. Standardization of morbidity assessment in breast cancer surgery using the Clavien Dindo Classification. International Journal of Surgery.2014;12(4):334-9. 
  14. Bank of Korea Economic Statistic System [Internet]. Seoul, Korea: Bank of Korea's Economic Statistic System (ECOS); 2023 [cited 2023 May 15]. Available from: https://ecos.bok.or.kr/#/StatisticsByTheme/MonetaryValue ; Bank of Korea. 
  15. Health Insurance Review and Assessment Service [Internet]. Gangwon-State, Korea: Health Insurance Review and Assessment Service 2023 [cited 2023 May 15]. Available from: http://www.hira.or.kr/co/search.do 
  16. Kim HS, Kim SO, Kim BS. Use of a clinical pathway in laparoscopic gastrectomy for gastric cancer. World Journal of Gastroenterology. 2015;21(48):13507-24. 
  17. Porter GA, Pisters PWT, Mansyur C, Bisanz A, Reyna K, Stanford P, et al. Cost and utilization impact of a clinical pathway for patients undergoing pancreaticoduodenectomy. Annals of Surgical Oncology.2000;7(7):484-9. 
  18. Soumerai SB, Starr D, Majumdar SR. How do you know which health care effectiveness research you can trust? A guide to study design for the perplexed. Preventing Chronic Disease.2015;12:E101. 
  19. Lopez Bernal J, Cummins S, Gasparrini A. The use of controls in interrupted time series studies of public health interventions. International Journal of Epidemiology. 2018;47(6):2082-93. 
  20. Ministry of Health and Welfare. Korea Central Cancer Registry. National Cancer Center. [Publication number 11-1352000-000145-10] Annual Report of Cancer Statistics in Korea in 2019. Ilsan, Korea: Ministry of Health and Welfare. Korea Central Cancer Registry. National Cancer Center; 2022. 
  21. Rotter T, Kinsman L, James E, Machotta A, Gothe H, Willis J, et al. Clinical pathways: effects on professional practice, patient outcomes, length of stay and hospital costs. Cochrane Database of Systematic Reviews. 2010;(3) 
  22. So JBY, Lim ZL, Lin HA, Ti TK. Reduction of hospital stay and cost after the implementation of a clinical pathway for radical gastrectomy for gastric cancer. Gastric Cancer. 2008;11(2):81-5. 
  23. Jackman DM, Zhang Y, Dalby C, Nguyen T, Nagle J, Lydon CA, et al. Cost and Survival Analysis Before and After Implementation of Dana-Farber Clinical Pathways for Patients With Stage IV Non-Small-Cell Lung Cancer. Journal of Oncology Practice. 2017;13(4):e346-52. 
  24. Hofmann PA. Critical path method: an important tool for coordinating clinical care. The Joint Commission Journal on Quality Improvement. 1993;19(7):235-46.