Long-term Outcome Following Case Management After Coronary Artery Bypass Surgery

Abstract

Patient outcome following coronary artery bypass grafting (CABG) has come under increasing governmental, social, and economic scrutiny. To insure quality patient outcome after CABG, many new policies and programs have been instituted. One of these, case management, was developed as a tool for identification and quantification of patient clinical sequences and resource utilization. This present study examines the influence of case management on length of stay and patient outcome following CABG. One hundred forty randomized, retrospectively analyzed CABG patients from 1990, prior to case management, were compared against 140 age‐and case‐matched randomly controlled CABG patients from 1994 after case management was in place. Patients' demographics were similar. The outcome data showed that intensive care unit (ICU) use and total length of stay were significantly decreased. Furthermore, resource utilization as monitored by chest X‐ray, electrocardiography, and laboratory testing were decreased as well. Finally, mortality was decreased despite an increase in risk‐adjusted acuity of the patients. There appeared to be no effect of gender or age on the benefit derived from case management. These data demonstrate that the influence of case management is beneficial for resource utilization and patient outcome following CABG and that these types of patient care policy advancements should be encouraged.

Coronary artery bypass graft (CABG) surgery patients in a clinical pathway gained less in health‐related quality of life as compared with patients who undergo CABG in a conventional‐care plan

“…This same trend has emerged in the past decade in relation to evaluating coronary artery bypass graft (CABG) pathways, ever since more comparative cohort studies were conducted to detect the effect of CABG pathways. It has been concluded that CABG pathways did decrease LOS, costs [8][9][10][11][12] and complications [13], but none of these studies provided any evidence regarding quality of life or depression, and anxiety.…”

Optimization of hospital stay through length-of-stay-oriented case management: an empirical study

“…In another study, Roddy et al were able to prove a 66 percent reduction in length of stay within a 4-year period in a vascular surgery department. Other studies include the use of intensive care units and patient mortalities (Walters et al 1998), treatment costs (Woods et al 1992) as well as unjustified procedures and the willingness of insurance companies to pay (Daniels 1999). All in all, medical as well as economic effects after introducing case management could be found (Yamamoto and Lucey 2005).…”