Electronic Clinical Pathways Program Improves Care for Several Disease States

Using an electronic system to guide clinical pathway usage can have substantial efficiency benefits over paper-based systems, a new study finds. 

Several studies have found that clinical pathways, when appropriately implemented, can improve patient outcomes, reduce variability in care, and yield cost savings. However, advances in technology have provided an opportunity to even further enhance the benefits associated with clinical pathway usage. 

In a prospective study at the Pharmacy Division of Xijing Hospital in Shaanxi, China, researchers evaluated the value of a software system called DRUGS (Drugs Rational Usage Guideline System) for implementing drug use guidelines and clinical pathways at the hospital. The system includes a database of rational drug use guidelines, which was evaluated and approved by the Chinese Medical Association and the heads of the hospital departments, as well as clinical pathways, which were designed by a multidisciplinary team on the basis of the available evidence.

Researchers, led by Jingwen Wang and Aidong Wen, evaluated the benefits of DRUGS-based clinical pathways for breast carcinoma, catract, inguinal hernia, and type 2 diabetes mellitus for improving patient care, reducing errors, and enhancing quality control, versus the use of paper-based guidelines and physician judgement for making treatment decisions. 

Out of a total 1773 patients, 901 patients were treated using paper-based guidelines between June 2013 and December 2013, and 872 were treated using a DRUGS-supported clinical pathway between June 2014 and December 2014. There were no significant differences between the patient populations in terms of age, body mass index, gender, or underlying disorder. Physicians using the DRUGS-based clinical pathway were able to opt out of the pathway when appropriate.

Across all disease states, the implementation of the DRUGS-based clinical pathways reduced total length of hospital stay and preoperative length of hospital stay by 1–3  days. Hospital costs also decreased significantly across all disease states. For the purposes of more detailed analysis, the researchers divided costs into seven specific categories. Four categories of costs—those associated with medications, examinations, operations, and antibiotics—decreased significantly. In contrast, costs associated with medical safety, unscheduled surgery, complications, and prognosis were not significantly affected by the use of the DRUGS-supported clinical pathway. 

“The results of our study demonstrate that implementation of [the] DRUGS-supported clinical pathway resulted in a decrease in length of hospital stay and cost, use of narrow-spectrum and less-expensive antibiotics, without having a negative impact on morbidity and mortality,” the authors concluded.

They added that further research would be needed to assess the long-term effects of pathway implementation on care quality and staff satisfaction. 

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Wang S, Zhu X, Zhao X, et al. DRUGS system improving the effects of clinical pathways: a systematic study. J Med Syst. 2016;40(3):59.