RESUMO
OBJECTIVE: To evaluate the durability over time of the reduction of resource utilization after implementing a clinical care pathway (CCP) for head and neck cancer surgery. DESIGN: Cohort study. SETTING: A tertiary care academic medical center. PATIENTS: We studied control subjects from 1995 (pre-CCP) (n = 87), a cohort from July 1, 1996, through July 31, 1997 (the first year after CCP implementation) (n = 43), and a cohort from 1999 (n = 82) after major resection and tracheostomy for upper aerodigestive tract cancer. INTERVENTIONS: Starting July 1, 1996, all patients undergoing major resection for head and neck cancer were treated using a CCP, which delineates daily interventions and goals. MAIN OUTCOME MEASURES: Length of stay (LOS), readmission and complication rates, and hospital charges. RESULTS: Median total LOS and LOS exclusive of the intensive care unit decreased in the first year and remained stable at 3 years (from 13.0 to 8.0 days and from 10.5 to 6.4 days, respectively). The intensive care unit LOS decreased across 3 years from 2.2 to 1.1 days (P=.001). Median total charges declined from 105,410 US dollars pre-CCP to 65,919 US dollars at 3 years. Incidence of postoperative pneumonia decreased from 12% to 1% (P=.02), and readmission rate decreased from 18% to 11% (P=.37) across 3 years. CONCLUSIONS: The CCP for head and neck cancer maintained the improvement in LOS and charges seen in the first year of implementation and continues to decrease resource utilization while enhancing quality of care.
