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Introducing a clinical pathway for acute peptic ulcer bleeding in general internal medicine wards
Teng-Yu Lee1, Tam Chan, Chi-Sen Chang
1Department of Internal Medicine, Division of Gastroenterology, Taichung Veterans General Hospital, Taichung, Taiwan. tylee@vghtc.gov.tw
Insights
Implementing a clinical pathway for acute peptic ulcer bleeding (PUB) significantly cut hospital costs and medication use. This approach proved effective in reducing expenses without negatively impacting patient outcomes like recurrent bleeding or readmission rates.
Area of Science:
- Gastroenterology
- Health Economics
- Clinical Management
Background:
- Acute peptic ulcer bleeding (PUB) management is costly with limited evidence on clinical pathway cost-effectiveness.
- Evaluating the economic impact of clinical pathways in acute PUB is crucial for optimizing healthcare resource allocation.
Purpose of the Study:
- To introduce and assess the impact of a clinical pathway on costs and outcomes in hospitalized patients with acute PUB.
- To determine if a structured clinical pathway can improve the cost-effectiveness of acute peptic ulcer bleeding management.
Main Methods:
- A clinical pathway and physician reminder system were implemented for hospitalized acute PUB patients.
- Key metrics compared pre- and post-implementation included acid suppression medication use, length of hospital stay (LOS), treatment costs, recurrent bleeding rates, repeat upper gastrointestinal (UGI) endoscopy rates, and 30-day readmission rates.
Main Results:
- The clinical pathway significantly reduced intravenous acid suppression medicine use (88% to 34%) and length of hospital stay (6.7 to 3.6 days).
- Mean medication costs decreased by 55.1%, diagnostic test costs by 24.4%, and total hospital costs by 41.1%.
- No significant differences were observed in recurrent bleeding, repeat UGI endoscopy, or 30-day readmission rates.
Conclusions:
- A clinical pathway is an effective strategy for reducing healthcare costs in acute peptic ulcer bleeding management.
- This approach successfully maintained the quality of care while achieving significant cost reductions.
Objective:
Management of acute peptic ulcer bleeding (PUB) is expensive and there is little evidence to prove the cost-effectiveness of a clinical pathway. The purpose of this study was to introduce a clinical pathway in hospitalized patients with acute PUB to evaluate its impact on costs and other outcomes.
Material And Methods:
The clinical pathway was designed for and implemented in hospitalized patients, and a physicians reminder system that included chief residents, checklists, and case review meetings was also utilized. Use of medicine for acid suppression, length of hospital stay (LOS), and treatment costs were compared between patients before and after implementation of the clinical pathway. Outcome measures included the rate of recurrent bleeding, rate of repeat upper gastrointestinal (UGI) endoscopy, and rate of readmission within 30 days of discharge.
Results:
This clinical pathway significantly reduced the use of intravenous medicine for acid suppression from 88% to 34%, with mean LOS down from 6.7 to 3.6 days, mean cost of medications decreased from New Taiwan Dollars (NTD) 8768 to NTD 3940 (cost down 55.1%), mean cost of diagnostic tests lowered from NTD 12,560 to NTD 9493 (cost down 24.4%), and mean total hospital cost down from NTD 33,142 to NTD 19,519 (cost down 41.1%). Outcome measures were not significantly different.
Conclusions:
Introduction of a clinical pathway is an effective method for reducing costs while maintaining quality of care in the management of PUB.
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