Biomedical subjects
Publications and source records attributed to D L Aspling.
Available experience indicates that physician support is crucial if clinical pathways are to support quality of care while reducing lengths of stay and resource use. Enlisting such support requires understanding of physician perspectives concerning the quality and delivery of health care. It also requires the development of data systems as a means of communication with physicians.
The study describes an effort to reduce hospital stays and limit the use of expensive resources in the metropolitan area of Syracuse, New York. The program included the implementation of clinical pathways for a number of surgical procedures and medical diagnoses. The effort involved the identification of specific resource variables in a wide range of clinical disciplines. The program was important because it focused on cooperative efforts at length of stay and resource reduction by the staffs of all of the hospitals within a common service area.
Benchmarks are criteria and standards for resource expenditure, as well as other variables, derived from organizations or communities which have been identified as models of the most effective and efficient practices. The development of benchmarks is crucial to reducing lengths of stay and related costs in hospitals. Useful sources for benchmarking data and how to access them are summarized.
Hospital utilization data for communities with high levels of managed care penetration can be readily used to develop utilization benchmarks in any proactive efforts to prepare for oncoming prospective pricing system (PPS) initiatives. In a cooperative effort among all four Syracuse, NY hospitals, the combined average hospital LOS for one surgical and three medical DRGs was compared with benchmarks derived from similar populations in three heavily managed care-penetrated west coast communities. Implementation of clinical or critical paths are a widely accepted approach to shortening hospital lengths of stay and improving both resource usage and clinical outcomes. After implementing clinical paths across all four institutions and revisiting their data a year later, a fairly dramatic reduction (28%) in mean LOS for total hip replacement procedures was achieved. Two of the three medical DRGs, stroke and acute MI, each showed a mean reduction of 17% in LOS.