Background: The implementation of Integrated Clinical Pathways (ICPs) is increasing in many hospitals in order to standardize care processes and orient them towards quality outcomes. Since 2017 the Hospital of Udine has implemented specific ICPs for vaginal (VD) and caesarean delivery (CD). The aim of the study is to investigate the effects of ICPs on both clinical and management outcomes. Methods: We used a pre and post study and compared two periods of six months (February-July 2016 for pre-ICPs and February-July 2017 for ICPs phase). We used data extracted from hospital discharge records (HDRs) and included all the patients admitted with the following ICD9-CM codes: V270; V271; V272; V276; 66970; 66971; 741; 744; 7499. We used Chi-square and Mann-Whitney test for analyzing: mothers’ age, type of delivery, length of stay (LOS), infection rate, perineal tears occurrence, 30-day re-hospitalization rate and costs. Results: Included patients were 730 for the pre-ICPs period and 739 for the ICPs one. Mean age (32.36±5.6 years for 2016; 32.11±5.4 years for 2017) and type of delivery (66.5% of VD and 33.4% of CD for 2016; 67.3% of VD and 32.6% of CD for 2017) did not differ significantly after the ICPs implementation. We found no differences in infection rate and LOS neither for VD nor for CD. 30-day re-hospitalization rate remained stable at < 1% for both years. The average costs of CD decreased significantly from 2016 (2449±1076€) to 2017 (2280±764€); (p < 0.05). First and second degree perineal tears after VD decreased significantly in 2017 (p < 0.01), from 62.5% to 22.9%. Conclusions: Our findings suggest that ICPs implementation for both vaginal and caesarean delivery positively influenced complications and costs outcomes. Others studies should be carried out to confirm this hypothesis, given the limited number of samples, and to evaluate the possibility of implementing ICPs in other fields of application and procedures. Key messages: Integrated Clinical Pathways implementation is oriented to both care standardization and quality improvement. The cost reduction effects associated with ICP as operational tool require careful assessment and continuous monitoring of its implementation.

Integrated Clinical Pathways in vaginal and caesarean delivery: effect analysis 2016-2017, Italy

Cagnacci A;
2018-01-01

Abstract

Background: The implementation of Integrated Clinical Pathways (ICPs) is increasing in many hospitals in order to standardize care processes and orient them towards quality outcomes. Since 2017 the Hospital of Udine has implemented specific ICPs for vaginal (VD) and caesarean delivery (CD). The aim of the study is to investigate the effects of ICPs on both clinical and management outcomes. Methods: We used a pre and post study and compared two periods of six months (February-July 2016 for pre-ICPs and February-July 2017 for ICPs phase). We used data extracted from hospital discharge records (HDRs) and included all the patients admitted with the following ICD9-CM codes: V270; V271; V272; V276; 66970; 66971; 741; 744; 7499. We used Chi-square and Mann-Whitney test for analyzing: mothers’ age, type of delivery, length of stay (LOS), infection rate, perineal tears occurrence, 30-day re-hospitalization rate and costs. Results: Included patients were 730 for the pre-ICPs period and 739 for the ICPs one. Mean age (32.36±5.6 years for 2016; 32.11±5.4 years for 2017) and type of delivery (66.5% of VD and 33.4% of CD for 2016; 67.3% of VD and 32.6% of CD for 2017) did not differ significantly after the ICPs implementation. We found no differences in infection rate and LOS neither for VD nor for CD. 30-day re-hospitalization rate remained stable at < 1% for both years. The average costs of CD decreased significantly from 2016 (2449±1076€) to 2017 (2280±764€); (p < 0.05). First and second degree perineal tears after VD decreased significantly in 2017 (p < 0.01), from 62.5% to 22.9%. Conclusions: Our findings suggest that ICPs implementation for both vaginal and caesarean delivery positively influenced complications and costs outcomes. Others studies should be carried out to confirm this hypothesis, given the limited number of samples, and to evaluate the possibility of implementing ICPs in other fields of application and procedures. Key messages: Integrated Clinical Pathways implementation is oriented to both care standardization and quality improvement. The cost reduction effects associated with ICP as operational tool require careful assessment and continuous monitoring of its implementation.
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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/11567/976530
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