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Home Healthcare Nurse:
Management Matters

A Clinical Pathway for Congestive Heart Failure

Hoskins, Lois M. PhD, RN, FAAN; Clark, Helene M. PhD, RN; Schroeder, Mary Ann DNSc, RNCS; Walton-Moss, Benita DNS, RNCS, FNP; Thiel, Sr.Linda DNSc, RNCS, FNP

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Part II of a study that compared two groups of elderly home health patients with congestive heart failure (CHF) is presented. One group’s plan of care was guided by a clinical pathway while the other group’s was not. As described in the first part of the study (published last month), the rehospitalization rate in the group not on the clinical pathway was 22.9% versus 12.5% in the clinical pathway group, a 45% reduction. In this article the pathway is presented, intermediate patient outcomes are described, and selected variables are analyzed for their impact on rehospitalization.

Home healthcare was hard hit by the 1997 Balanced Budget Act, and with the Prospective Payment System (PPS) the premiere question is: Are cost containment and quality compatible? If cost control is imposed, will patient care suffer?

As described in the article, “Clinical Pathways Versus a Usual Plan of Care: What’s the Difference” in last month’s issue of HHN, patients with congestive heart failure (CHF) in the study who received care guided by the use of a clinical pathway had significantly lower hospital readmission rates than patients not on the pathway.

Use of a clinical pathway has been cited by many authors as a way to reduce costs through an inclusive and systematic approach to caring for patients with specific diagnoses. A reduction in the rate of hospitalization can be seen as not only cost effective but also as a quality indicator. Based on this study and other results of caring for patients with CHF at home with a clinical pathway, the answer to the compatibility issue is “yes, cost containment and quality are compatible.”

© 2001 Lippincott Williams & Wilkins, Inc.


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