Cost-effectiveness of Clinical Pathway in Coronary Artery Bypass Surgery

Lin, Yung-Kai; Chen, Chia-Pin; Tsai, Wen‐Chen; Chiao, Yu‐Ching; Lin, Blossom Yen-Ju

doi:10.1007/s10916-009-9357-7

Cited by 10 publications

(10 citation statements)

References 25 publications

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“…In more recent years, only a few studies have assessed the cost-effectiveness of integrated care pathways, and among these studies, the patient groups and settings where the pathways were implemented, vary widely. [ 25 – 29 ]…”

Section: Introductionmentioning

confidence: 99%

An economic evaluation of an integrated care pathway in geriatric rehabilitation for older patients with complex health problems

et al. 2018

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BackgroundIntegrated care pathways which cover multiple care settings are increasingly used as a tool to structure care, enhance coordination and improve transitions between care settings. However, little is known about their economic impact. The objective of this study is to determine the cost-effectiveness and cost-utility of an integrated care pathway designed for patients with complex health problems transferring from the hospital, a geriatric rehabilitation facility and primary care.MethodsThis economic evaluation was performed from a societal perspective alongside a prospective cohort study with two cohorts of patients. The care as usual cohort was included before implementation of the pathway and the care pathway cohort after implementation of the pathway. Both cohorts were measured over nine months, during which intervention costs, healthcare costs, patient and family costs were identified. The outcome measures were dependence in activities of daily living (measured with the KATZ-15) and quality adjusted life years (EQ-5D-3L). Costs and effects were bootstrapped and various sensitivity analyses were performed to assess robustness of the results.ResultsAfter nine months, the average societal costs were significantly lower for patients in the care pathway cohort (€50,791) versus patients in the care as usual cohort (€62,170; CI = -22,090, -988). Patients in the care pathway cohort had better scores on the KATZ-15 (1.04), indicating cost-effectiveness. No significant differences were found between the two groups on QALY scores (0.01).ConclusionsThe results of this study indicate that the integrated care pathway is a cost-effective intervention. Therefore, dissemination of the integrated care pathway on a wider scale could be considered. This would provide us the opportunity to confirm the findings of our study in larger economic evaluations. When looking at QALYs, no effects were found. Therefore, it is also recommended to explore if therapy in geriatric rehabilitation could also pay attention to other quality of life-related domains, such as mood and social participation.

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Section: Introductionmentioning

confidence: 99%

An economic evaluation of an integrated care pathway in geriatric rehabilitation for older patients with complex health problems

et al. 2018

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“…Both type 1 and type 2 diabetes can increase hip fracture risk and complications due to abnormal bone metabolism [ 4 , 5 ]. Vestergaard found that compared with those without diabetes, the relative risk (RR) for hip fractures in patients with type 1 diabetes was 6.94, and that for hip fractures in patients with type 2 diabetes was 1.38 [ 6 ]. In other studies, patients with longer diabetes duration were associated with a higher hip fracture risk compared to patients without diabetes.…”

Section: Introductionmentioning

confidence: 99%

Associations of body mass index and diabetes with hip fracture risk: a nationwide cohort study

et al. 2018

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BackgroundThe high prevalence of diabetes is associated with body mass index (BMI), and diabetes can cause many complications, such as hip fractures. This study investigated the effects of BMI and diabetes on the risk of hip fractures and related factors.MethodsWe retrospectively reviewed data from 22,048 subjects aged ≧ 40 years from the National Health Interview Survey in Taiwan (NHIST) in 2001, 2005, and 2009. We linked the NHIST data for individual participants with the National Health Insurance Research Database (NHIRD), which includes the incidence of hip fracture from 2000 to 2013. We defined five categories for BMI: low BMI (BMI < 18.5), normal BMI (18.5 ≦ BMI < 24), overweight (24 ≦ BMI < 27), mild obesity (27 ≦ BMI < 30), and moderate obesity (BMI ≧ 30). The Cox proportional hazards model was used to analyze the effects of BMI and diabetes on risk of hip fracture.ResultsThe Cox proportional hazards model shows that hip fracture risk in participants with diabetes was 1.64 times that of non-diabetes patients (95% confidence interval [CI]:1.30–2.15). Participants with low BMIs showed a higher hip fracture risk (HR: 1.75) than those with normal BMI. Among the five BMI groups, compared with non-diabetes patients, only diabetes patients with a normal BMI showed a significantly higher risk on hip fracture (HR: 2.13, 95% CI: 1.48–3.06). In participants with diabetes, compared with those with normal BMI, those with overweight or obesity showed significantly lower hip fracture risks (HR: 0.49 or 0.42). The hip fracture risk in participants who expend ≧ 500 kcal/week in exercise was 0.67 times lower than in those who did not exercise.ConclusionsDiabetes and low BMI separately are important risk factors for hip fracture. There was an interaction between diabetes and BMI in the relationship with hip fracture (p = 0.001). The addition of energy expenditure through exercise could effectively decrease hip fracture risk, regardless of whether the participants have diabetes or not. The results of this study could be used as a reference for health promotion measures for people with diabetes.

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“…One important issue for all fast‐track protocols or CPs is the concern for increased complications or hospital readmission. CPs for CABG patients have been shown to be safe, and have not caused an increase in the rate of postoperative complications (Lin, Chen, Tsai, Chiao, & Lin, ). Additionally, early discharge of patients does not lead to an increase in readmission rates (El Baz, Middel, Van Dijk, Boonstra, & Reijneveld, ; van Mastrigt et al., ).…”

Section: Discussionmentioning

confidence: 99%

Effects of nurse‐led clinical pathway in coronary artery bypass graft surgery: A quasi‐experimental study

Kebapçı

Kanan

2018

Journal of Clinical Nursing

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Cost-effectiveness of Clinical Pathway in Coronary Artery Bypass Surgery

Cited by 10 publications

References 25 publications

An economic evaluation of an integrated care pathway in geriatric rehabilitation for older patients with complex health problems

An economic evaluation of an integrated care pathway in geriatric rehabilitation for older patients with complex health problems

Associations of body mass index and diabetes with hip fracture risk: a nationwide cohort study

Effects of nurse‐led clinical pathway in coronary artery bypass graft surgery: A quasi‐experimental study

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