Feasibility and economic impact of a clinical pathway for pap test utilization in Gynecologic Oncology practice

Santillan, Antonio; Govan, Linda; Zahurak, Marianna; Díaz-Montes, Teresa; Giuntoli, Robert L.; Bristow, Robert E.

doi:10.1016/j.ygyno.2008.01.006

Cited by 10 publications

(5 citation statements)

References 17 publications

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“…Although this is significantly less than the $75 040 per patient recurrence reported by Bristow et al (2006) in their endometrial cancer study; our data, nevertheless, suggest that routine vaginal cytology does not have prognostic utility nor is it financially justifiable in ovarian cancer surveillance (Santillan et al , 2008). …”

Section: Discussioncontrasting

confidence: 72%

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The utility and cost of routine follow-up procedures in the surveillance of ovarian and primary peritoneal carcinoma: a 16-year institutional review

Rettenmaier¹,

Rettenmaier²,

Wojciechowski

et al. 2010

Br J Cancer

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Background:The purpose of this study was to evaluate the number of ovarian cancer and primary peritoneal cancer (PPC) progressive disease cases identified via routine follow-up procedures and the corresponding cost throughout a 16-year period at a single medical institution.Methods:Previously undiagnosed epithelial ovarian (n=241), PPC (n=23), and concurrent ovarian and uterine (n=24) cancer patients were treated and then followed via CA-125, imaging (e.g., CT scan, chest X-ray), physical examination and vaginal cytology.Results:In the group of 287 patients, there were 151 cases of disease progression. Serial imaging detected the highest number of progressive disease cases (66 initial and 45 confirmatory diagnoses), but the cost was rather high ($13 454 per patient recurrence), whereas CA-125 testing (74 initial and 20 corroborative diagnoses) was the least expensive ($3924) per recurrent diagnosis. The total cost of surveillance during the 16-year period was nearly $2 400 000.Conclusion:Ultimately, serial imaging and the CA-125 assay detected the highest number of ovarian cancer and PCC progressive disease cases in comparison to physical examination and vaginal cytology, but nevertheless, all of the procedures were conducted at a considerable financial expense.

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Section: Discussioncontrasting

confidence: 72%

“…Vaginal cytology has been included in the intense follow-up of gynaecologic cancers (Santillan et al , 2008). However, this procedure has not proven to have sufficient external validity in effectuating a favourable clinical outcome (Milam et al , 2007).…”

Section: Discussionmentioning

confidence: 99%

The utility and cost of routine follow-up procedures in the surveillance of ovarian and primary peritoneal carcinoma: a 16-year institutional review

Rettenmaier¹,

Rettenmaier²,

Wojciechowski

et al. 2010

Br J Cancer

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“…Contemporary socioeconomic pressures for more cost-efficient delivery of medical care are strong motivating forces for the development of a fast-track clinical pathway. To date, some studies have found that the fast-track clinical pathways can lead to a decrease in postoperative length of stay (LOS) and hospital charges, such as in colorectal [2, 3], vascular [4, 5], obstetric [6], urologic [7, 8], and pediatric procedures [9]. However, its role in hepatic surgery is still controversial.…”

Section: Introductionmentioning

confidence: 99%

Implementation of a Fast-Track Clinical Pathway Decreases Postoperative Length of Stay and Hospital Charges for Liver Resection

Lin¹,

et al. 2011

Cell Biochem Biophys

104

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A fast-track clinical pathway is designed to streamline patient care delivery and maximize cost effectiveness. It has decreased postoperative length of stay (LOS) and hospital charges for many surgical procedures. However, data on clinical pathways after liver surgery are sparse. This study examined whether use of a fast-track clinical pathway for patients undergoing elective liver resection affected postoperative LOS and hospital charges. A fast-track clinical pathway was developed and implemented by a multidisciplinary team for patients undergoing liver resection. Between July, 2007 and May, 2008, a total of 117 patients underwent elective liver resection: the fast-track clinical pathway (education of patients and families, earlier oral feeding, earlier discontinuation of intravenous fluid, no drains or nasogastric tubes, early ambulation, use of a urinary catheter for less than 24 h and planned discharge 6 days after surgery) was studied prospectively in 56 patients (postpathway group). These patients were compared with the remainder who had usual care (prepathway group). Outcome measures were postoperative LOS, perioperative hospital charges, intraoperative and postoperative complications, mortality, and readmission rate. Among all patients, 69 (59%) had complicating diseases and/or a history of surgery and 24 patients belonged to American Society of Anesthesiologists grade III–IV. Compared with the prepathway group, the postpathway group had a significantly shorter postoperative LOS (7 vs. 11 days, P < 0.01). The average perioperative hospital charges were RMB 26,626 for patients in the prepathway group and only RMB 21,004 for those in the postpathway group (P < 0.05), with no differences in intraoperative and postoperative complications (P = 0.814), mortality (P = 0.606), and readmission rate (P = 0.424). Implementation of the fast-track clinical pathway is an effective and safe method for reducing postoperative LOS and hospital charges for high-risk patients undergoing elective liver resection. The result supports the further development of fast-track clinical pathways for liver surgical procedures.

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“…The CP is used for the treatment of many medical conditions across the continuum of care [3-5]. Some studies have found that the critical pathways can lead to a decrease in postoperative length of stay and hospital charges, such as in colorectal [6,7], liver [8], vascular [9,10], obstetric [11], urologic [12,13], and pediatric procedures [14]. …”

Section: Introductionmentioning

confidence: 99%

Is the critical pathway effective for the treatment of gastric cancer?

et al. 2011

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PurposeThe present study was conducted to investigate the low compliance rate of the critical pathway (CP) and whether CP is effective for treatment of gastric cancer in radical gastrectomy.MethodsThe medical records of 631 patients who had undergone radical gastrectomy with D2 lymph node dissection were reviewed. This study compared data from patients in early gastric cancer (EGC) and advanced gastric cancer (AGC) groups, which were further subdivided into general care (non-CP) and CP groups.ResultsThe mean length of preoperative hospital stays were significantly different between the EGC and AGC patients (P < 0.05). However, there was no difference in the mean length of postoperative hospital stays between non-CP and CP groups among either EGC patients or AGC patients (P > 0.05). The postoperative and total cost of hospitalization was not statistically different between either of the groups (P > 0.05); however, the mean preoperative costs were significantly different (P < 0.05).ConclusionWe conclude that use of the CP following gastrectomy is unnecessary. To decrease the length of hospital stay and associated costs, preoperative examination and consultation should be performed before admission.

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Feasibility and economic impact of a clinical pathway for pap test utilization in Gynecologic Oncology practice

Cited by 10 publications

References 17 publications

The utility and cost of routine follow-up procedures in the surveillance of ovarian and primary peritoneal carcinoma: a 16-year institutional review

The utility and cost of routine follow-up procedures in the surveillance of ovarian and primary peritoneal carcinoma: a 16-year institutional review

Implementation of a Fast-Track Clinical Pathway Decreases Postoperative Length of Stay and Hospital Charges for Liver Resection

Is the critical pathway effective for the treatment of gastric cancer?

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