Economic effect of critical pathway for the patient with mild stroke

Abstract

The patients with cerebral infarction show variable neurological symptoms and variable pattern of recovery. Critical pathway is the method to facilitate recovery and shorten the length of stay by standardizing the course of therapy and care. Validity of critical pathway for the patient with cerebral infarction has not established yet. We developed critical pathway for the patient with acute mild cerebral infarction and analyzed clinical effect of the pathway. This is historically controlled non-randomized case-controlled study. The control group includes 37 cases admitted between August and November in 2003, before the introduction of the critical path way. The critical pathway was used for 35 cases admitted between November 2003 and May 2004. Among these 35 cases, only 1 patient failed to complete the pathway, because he developed pneumonia after admission. So critical pathway group included 34 cases that completed the pathway. Our stroke critical pathway includes the order of the infusion of anti-platelet drug (Ozagrel Na, Cataclot^®, Ono Pharmaceutical Co. Ltd., Osaka, Japan) and free radical scavenger (Edaravone, Radicut ^®, Mitsubishi Pharma Co., Osaka, Japan) for 2 weeks. The length of stay and infusion was determined by the doctor in charge, depending on the patient condition. There were no significant differences in backgrounds, symptoms, responsible lesions, neurological findings, ADL, complications, accompanying diseases between control and pathway groups. Mean length of stay was 19.9 days for control group, and 15.1 days for critical path group. Critical path group showed statistically significant shortening of mean and variance of the length of stay. Critical path group showed lower hospital charge for rehabilitation and basic hospital stay, and higher charge for infusion. Total hospital charge showed no difference between 2 groups. The introduction of critical pathway had positive economic effect and the revision of critical pathway will bring better effects.