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Effectiveness of the clinical pathway in the management of congestive heart failure

Aparna Ranjan1, Leena Tarigopula, Rakesh K Srivastava

  • 1Greater Baltimore Medical Center, Baltimore, MD 21204, USA.

Southern Medical Journal
|August 28, 2003
PubMed

Insights

Implementing a clinical pathway for congestive heart failure (CHF) significantly reduced hospital stays and costs. This pathway also increased the use of essential angiotensin-converting enzyme (ACE) inhibitors for CHF patients.

Area of Science:

  • Cardiology
  • Health Services Research
  • Clinical Pathways

Background:

  • Congestive heart failure (CHF) affects 4 million Americans, costing over $8 billion annually.
  • Existing CHF clinical pathways lack rigorous evaluation for efficacy and quality improvement.
  • This study evaluates a CHF clinical pathway's impact on hospital resource utilization and ACE inhibitor use.

Purpose of the Study:

  • To assess the effectiveness of a clinical pathway for congestive heart failure (CHF).
  • To determine the pathway's impact on hospital charges and length of stay.
  • To evaluate the influence of the pathway on angiotensin-converting enzyme (ACE) inhibitor utilization.

Main Methods:

  • Retrospective cohort study of 371 patients with CHF diagnoses.
  • Data collected via chart reviews from July 1996 to December 1997.
  • Comparison of patients on a clinical pathway versus those not on the pathway.

Main Results:

  • Patients on the pathway achieved a <4-day stay 65% of the time vs. 42% off-pathway (OR 2.6, P<0.001).
  • Median hospital charges were lower for the pathway group ($3,000 vs. $5,500, P<0.001).
  • ACE inhibitor use was higher in the pathway group (81% vs. 48%, OR 4.68, P<0.001).

Conclusions:

  • The CHF clinical pathway improved patient care outcomes.
  • Pathway implementation led to reduced length of stay and hospital charges.
  • Clinical pathways are effective in increasing the use of ACE inhibitors for CHF patients.
Abstract

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