Do Clinical Pathways Really Improve Clinical Preformance?

Sunday, November 1, 2009

Tjitze S. Hoekstra, MSc, RN
Department of Cardiology and Pulmonary Diseases, St. Antonius Hospital Nieuwegein, Utrecht, Netherlands

Learning Objective 1: The learner will be able to identify the effect of a DTC for COPD care in a Dutch Teaching Hospital.

Learning Objective 2: The learner will be able to learn more about the Dutch Healthcare system.

In 2003 the first clinical pathways were introduced in the St. Antonius Hospital, The Netherlands’ a first and foremost specialist heart and lung centre. Clinical Pathways should help the multidisciplinary team to work together and set their common goals. It must guide the team towards optimal quality and patient-focused workflow.   But how to measure the outcome of a better workflow? What was the impact on length of stay after the introduction of the COPD clinical pathway?   On January 1st, 2005, a new financing system for hospitals was introduced. This system is based on the so-called ‘Diagnosis Treatment Combination’ (DTC). A DTC includes all the activities and actions performed by the hospital and medical specialist in response to the patient’s need for care, from the first consultation or examination to the final checkup. A DTC gives better insight into treatments performed by hospitals and the cost of such treatments, so that healthcare insurers know exactly what they are paying for and can compare hospitals. Every hospital is required to use DTC's in order to determine the total cost of a medical treatment.   There are approximately 316,400 people in the Netherlands that have received diagnoses Chronic Obstructive Pulmonary Disease (COPD). The St. Antonius Hospital has developed a clinical pathway for patients that have COPD and implemented it in august 2008. The DTC was used to optimize the clinical path. The results were impressive. In 2000 the modus for a COPD admission was 26 days, in 2008 before implementing the clinical pathway 10 days and after implementing the modus decreased to 8 days.   A DTC is a good tool to support the development of a multidisciplinary clinical pathway. It also offers the possibility to assess the impact of a clinical pathway.