Use of Algorithmic Pathways to Develop Quality Care Oriented, Cost Effective Clinical Care

This study analyzed the cost of diagnosis of hydrosalpinges and pelvic adhesions using four pathways. This is an example of the use of algorithmic pathways in developing medical service delivery which provides quality care to women while maintaining cost-effectiveness. The four pathways are: Chlamydia IgG antibody titer -> hysterosalpingogram -> diagnostic laparoscopy; chlamydia IgG titer -> diagnostic laparoscopy, hysterosalpingogram -> diagnostic laparoscopy; and diagnostic laparoscopy with no preliminary studies. These pathways are limited in that they require several assumptions that are not based on biologic data and do not include history, physical, other laboratory finding or other disease processes. However, with these limitations, the least costly approach to the diagnosis of 19 of 26 of the hydrosalpinges was pathway one with a total cost of $103,120. On the other hand, pathway three, with a total cost of $139,440 and a yield of 26 of 27 hydrosalpinges, was less expensive per patient with a cost of $5,363 as compared with the per patient cost of $5,427 using pathway one. In analyzing pelvic adhesions, pathway one was the least expensive at $186,280 but yielded only 13 (42%) of 31 patients with adhesions. Pathway four was the most expensive overall at $332,640 but was the least expensive per patient diagnosis at $10,730. Developing these type pathways will require computer assistance. However, even computer assistance will be inadequate without biologically significant data and without well defined goals and expectations.