Causation between Pathway Completion and Reduced Hospital Stay in Patients with Lung Cancer: a Retrospective Cohort Study Using Propensity Score Matching

Abstract

We have previously demonstrated that clinical pathway completion helps reduce hospital stays. However, our previous results showed only a correlation, not causation. Therefore, the current study's aim was to analyze the causation between clinical pathway completion and reduced hospital stays for patients with lung cancer. Data were collected from April 2013 to March 2018 from the electronic medical records of the University of Miyazaki Hospital. We used propensity score matching to extract records from 227 patients. Patients were further divided into a pathway completed group and a pathway not completed group; 74 patients in each group were available for data analysis. Our main analysis involved estimating the discharge curve, which was comprised of the in-hospital rate and hospital stay. Additional analyzes were performed to compare the frequency of medical treatments registered in the clinical pathway but not implemented (termed deviated medical treatments). The occurrence of these treatments meant that the clinical pathway was not completed. The main results indicated a decrease in the in-hospital rate of the completion group, compared with the not completed group. The p value of the log-rank test was <0.001 for total patients and patients who underwent resection, and 0.017 for patients who did not undergo resection. Additional results indicated that a number of intravenous drips were not implemented, despite their registration on clinical pathways. Our results indicate that clinical pathway completion contributes to improved efficiency and safety. This simplified procedure is expected to be applicable to other diseases and clinical indicators.

Financial Estimation of the Uncertainty in Medicine Using Present Value of Medical Fees and a Mortality Risk Prediction Model: a Retrospective Cohort Study

“…Second, the method employs LHS as an exposure time of treatment risk in medicine but not an efficiency indicator. Although various research articles [45][46][47][48][49] have demonstrated the importance of decreasing LHS, the present study has discussed LHS from different perspectives. Finally, the practice of attaching too much importance to decreasing LHS is criticized herein because of the social health insurance system in Japanese acute medical organizations called the Diagnosis Procedure Combination (DPC) payment system.…”