Standardized Clinical Pathways for Hospitalized Children and Outcomes

Abstract

BACKGROUND AND OBJECTIVE: Clinical pathways standardize care for common health conditions. We sought to assess whether institution-wide implementation of multiple standardized pathways was associated with changes in utilization and physical functioning after discharge among pediatric inpatients. METHODS: Interrupted time series analysis of admissions to a tertiary care children’s hospital from December 1, 2009 through March 30, 2014. On the basis of diagnosis codes, included admissions were eligible for 1 of 15 clinical pathways implemented during the study period; admissions from both before and after implementation were included. Postdischarge physical functioning improvement was assessed with the Pediatric Quality of Life Inventory 4.0 Generic Core or Infant Scales. Average hospitalization costs, length of stay, readmissions, and physical functioning improvement scores were calculated by month relative to pathway implementation. Segmented linear regression was used to evaluate differences in intercept and trend over time before and after pathway implementation. RESULTS: There were 3808 and 2902 admissions in the pre- and postpathway groups, respectively. Compared with prepathway care, postpathway care was associated with a significant halt in rising costs (prepathway vs postpathway slope difference –$155 per month [95% confidence interval −$246 to −$64]; P = .001) and significantly decreased length of stay (prepathway vs post-pathway slope difference –0.03 days per month [95% confidence interval −0.05 to −0.02]; P = .02), without negatively affecting patient physical functioning improvement or readmissions. CONCLUSIONS: Implementation of multiple evidence-based, standardized clinical pathways was associated with decreased resource utilization without negatively affecting patient physical functioning improvement. This approach could be widely implemented to improve the value of care provided.