Document Detail

Clinical pathway management of total knee arthroplasty.
MedLine Citation:
PMID:  9418629     Owner:  NLM     Status:  MEDLINE    
Using a retrospective cohort study design, the authors examined complications, readmissions, morbidity and mortality, and function scores in two groups of patients attended by the same surgeon for the year before and the year after the implementation of an outcomes management program with clinical pathways for patients undergoing total knee arthroplasty at an academic health center. The effectiveness of the pathway constantly was adjusted using variance analysis and continuous quality improvement techniques. This program reduced the length of stay by 57% from a premanagement value of 10.9 +/- 5.4 days in 1994 (Group 1) to 4.7 +/- 1.4 days in 1996 (Group 2). Hospital costs (based on an inflation adjusted cost to charge ratio) for all total knees were reduced 11% from $13,328 +/- $3905 in 1994 to $11,862 +/- $4763 in 1996. Preoperative and postoperative knee scores were 41.1 +/- 16.3 and 84.2 +/- 16.0 for Group 1 and 42.5 +/- 13.0 and 87.0 +/- 10.4 for Group 2, respectively. There was no statistically significant difference between the preoperative or the postoperative knee scores of Groups 1 and 2. The application of clinical pathways, variance analysis, and continuous quality improvement toward the treatment of patients who had total knee arthroplasty at an academic health center resulted in significant savings in length of stay without adversely affecting overall outcome.
J D Mabrey; J S Toohey; D A Armstrong; L Lavery; L A Wammack
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Clinical orthopaedics and related research     Volume:  -     ISSN:  0009-921X     ISO Abbreviation:  Clin. Orthop. Relat. Res.     Publication Date:  1997 Dec 
Date Detail:
Created Date:  1998-01-21     Completed Date:  1998-01-21     Revised Date:  2005-03-03    
Medline Journal Info:
Nlm Unique ID:  0075674     Medline TA:  Clin Orthop Relat Res     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  125-33     Citation Subset:  AIM; IM    
Department of Orthopaedics, University of Texas Health Science Center at San Antonio 78284-7774, USA.
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MeSH Terms
Academic Medical Centers / economics,  statistics & numerical data
Analysis of Variance
Arthroplasty, Replacement, Knee* / adverse effects,  economics,  mortality,  statistics & numerical data
Cohort Studies
Critical Pathways*
Follow-Up Studies
Hospital Charges
Hospital Costs
Inflation, Economic
Length of Stay / statistics & numerical data
Middle Aged
Outcome Assessment (Health Care)
Patient Discharge
Patient Readmission
Range of Motion, Articular
Retrospective Studies
Texas / epidemiology
Total Quality Management

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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