Evaluation of clinical pathway in acute ischemic stroke: A comparative study

IntroductionStroke is the leading cause of death and disability in Chinese adults and brings huge economic burden to the country. Clinical pathways (CP) have been shown to improve outcomes and reduce hospitalization costs and length of stay (LOS) for stroke patients. The objective of this study was to evaluate whether integrating Chinese medicine and western medicine into a clinical pathway for stroke could affect length of stay, hospitalization costs and clinical efficacy.MethodThis multicenter study consisted of a prospective clinical (CP) and a retrospective clinical study (RCP). Participants in the CP group accepted Chinese medicine and western medicine treatments based on a standard CP protocol while the subjects in RCP group had been offered routine treatment based on the doctors' personal experience. The information from participants in RCP group was retrospectively collected from the electronic medical system including the demographic characteristics, medical history, neurological impairment evaluation, LOS, hospitalization cost, and critical evidence-based processes in both western medicine and Chinese Medicine. The prospective study was conducted between 18th January to 30th, August, 2010 and the data collection on RCP participants were carried out at the same time.The primary outcome measure was LOS while hospitalization cost, clinical efficacy, adherence of critical processes and incidence of complications were secondary outcome measures.ResultsLOS in CP and RCP group was 17.2 days and 21.4 days (P < 0.001) while hospitalization cost was 1776 US$ and 2433 US$ in CP and RCP group, respectively. 216 Patients (72.7%) in CP group compared to 401 patients (55.1%) in RCP group had improved clinical outcomes (P < 0.001). Adherence to all evidence-based critical processes in CP group was better than RCP group (P < 0.001). The multivariate analysis showed that after adjusting the conventional risk factors, CP application also played an important role in shortening LOS, reducing cost and improving clinical outcomes.ConclusionA clinical pathway for ischemic stroke based on the integration of Chinese medicine and western medicine was effective in shortening LOS, reducing hospitalization cost, improving clinical outcomes and elevating adherence to evidence-based critical processes.