2009 Volume 49 Issue 4 Pages 435-440
Objectives. Clinical pathways have become more common in clinical practice in Japan to improve costeffectiveness, allocation, and timing of medical services. Our clinical pathway for thoracotomy is applied in Japanese standard medical practice for surgery in patients with lung cancer. This study was designed to validate the appropriateness of our standard pathway for thoracotomy and to estimate the profit and loss situation in the Diagnosis Procedure Combination (DPC) payroll system of the Japanese Health Insurance system. Methods and Results. From November 2005 through August 2007, chest surgery was performed in 448 patients. Our clinical pathway was applied in 94.4% of these patients; 7.3% patients dropped out because of variance. The average hospital stay was 8.7 days in the patients who did not drop from pathway. The re-admission rate within 1 month after discharge was 0.8%. The mean number of variances was 1.6. Patient-related variance was most frequent (cardiovascular related, 31.5%; pain-related, 30.0%). During the study, we shortened the duration of treatment with antibiotics according to the CDC guidelines as recommended by the Japanese Surgical Society (3 days to 1 day). This did not increase the rate of surgical-site infections (0.9% to 1.1%, p>0.99). The profit and loss situation with the DPC payroll system was not inferior to that of the previous Japanese medical payment system (fee for service reimbursement, 1,212,150 yen with DPC, 1,176,910 yen with the previous system). Conclusion. Our clinical pathway for thoracotomy is rational and adequate. Implementation of the DPC system has not lead to any financial disadvantage.
