Standardized Clinical Pathways for Hospitalized Children and Outcomes

Abstract

Background and Objective Clinical pathways standardize care for common health conditions. We sought to assess whether institution-wide implementation of multiple standardized pathways was associated with changes in utilization and physical functioning after discharge among pediatric inpatients. Methods Interrupted time series analysis of admissions to a tertiary care children’s hospital from 12/1/09–3/30/14. Based on diagnosis codes, included admissions were eligible for one of 15 clinical pathways implemented during the study period; admissions from both before and after implementation were included. Post-discharge physical functioning improvement was assessed with the PedsQL™ 4.0 generic core or infant scales. Average hospitalization costs, length of stay (LOS), readmissions, and physical functioning improvement scores were calculated by month relative to pathway implementation. Segmented linear regression was used to evaluate differences in intercept and trend over time before and after pathway implementation. Results There were 3808 and 2902 admissions in the pre-pathway and post-pathway groups, respectively. Compared to pre-pathway care, post-pathway care was associated with a significant halt in rising costs (pre-pathway vs. post-pathway slope difference −$155/month [95% CI −$246, −$64]; P=.001) and significantly decreased LOS (pre-pathway vs. post-pathway slope difference −0.03 days per month [95% CI −0.05, −0.02]; P= .02), without negatively impacting patient physical functioning improvement or readmissions. Conclusions Implementation of multiple evidence-based, standardized clinical pathways was associated with decreased resource utilization without negatively impacting patient physical functioning improvement. This approach could be widely implemented to improve the value of care provided.

Association of Bronchiolitis Clinical Pathway Adherence With Length of Stay and Costs

“…4,11,17,18 Studies to date have not compared the impact of adherence to specific care processes within bronchiolitis pathways on health care outcomes, limiting our understanding of how extensively pathways are implemented and applied to each individual patient. 19 Our objective was to evaluate the impact of adherence to standardized clinical processes of care for bronchiolitis on health care use and costs in the pediatric emergency department (ED) and inpatient settings.…”

The Snowball Effect of Low-Value Care

“…Although no guideline fits every patient or replaces clinical judgment, evidence-based practice guidelines allow for meaningful discourse around current literature and can promote value-based shared decisionmaking. 25,26 This case highlights how 1 decision, albeit seemingly benign, can lead to rapid snowballing of low-value care. For this infant, adherence to published guidelines at 3 separate points could have prevented or halted the low-value care spiral.…”

Costs of Care for Hospitalized Children Associated With Preferred Language and Insurance Type

“…These lower cost findings were primarily driven by children with medical complexity and longer LOS. Since many of the children without medical complexity at our institution receive medical care that is standardized by diagnosis, 33 there may have been fewer opportunities to provide unequal care based on family characteristics or provider biases for those children.…”