印旛脳卒中地域連携パスの効果

抄録

We launched the Inba Clinical Pathway for local Stroke network (InCliPS) as a stroke liaison critical pathway (SLCP) in northwest Chiba Prefecture on March 10, 2008. The aim of this study was to investigate the effects of the InCliPS on the length of hospitalization and on outcomes in stroke patients. We reviewed 1,599 consecutive patients with acute stroke admitted to Nippon Medical School Chiba Hokusoh Hospital from January 2007 through December 2009. The InCliPS was applied to 24.4% of patients in 2008 and to 32.7% of patients in 2009. The mean length of acute hospitalization was 20.8±15.2 days in 2007, 19.8±14.5 days in 2008, and 19.1±12.5 days in 2009 and had, therefore, decreased by 1.7 days over 3 years. In patients for whom the InCliPS path sheets were used, the mean length of hospitalization was 30.3±17.2 days in 2008 and 26.6±13.5 days in 2009. In 181 cases, the patients satisfied the applicable criteria for the InCliPS but the path sheets were not used. The mean length of hospitalization of these patients was 19.7±12.8 days in 2008 and 20.9±12.2 days in 2009. The modified Rankin scale at discharge from the acute hospital and the rehabilitation hospitals did not differ significantly between 2008 and 2009. Our data show that the SLCP contributes to the efficiency of regional stroke care. For constructing evidence for a medical network, however, better systems are needed to evaluate the efficacy of the SLCP.