Abstract
Clinical pathways are known to improve the value of health care in medical and surgical settings but have been rarely studied in the psychiatric setting. This study examined the association between level of adherence to an adolescent depressive disorders inpatient clinical pathway and length of stay (LOS), cost, and readmissions. Patients in the high adherence category had significantly longer LOS and higher costs compared to the low adherence category. There was no difference in the odds of 30-day emergency department return visits or readmissions. Understanding which care processes within the pathway are most cost-effective for improving patient-centered outcomes requires further investigation.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Barben, J., Kuehni, C. E., Trachsel, D., & Hammer, J. (2008). Management of acute bronchiolitis: Can evidence based guidelines alter clinical practice? Thorax, 63, 1103–1109. https://doi.org/10.1136/thx.2007.094706.
Basu, A. (2017). Estimating costs and valuations of non-health benefits in cost-effectiveness analysis. In P. Neumann, G. Sanders, L. Russell, J. Siegel & G. Theodore (Eds.), Cost-effectiveness in health and medicine (pp. 201–236). New York, NY: Oxford University Press.
Berry, J. G., Toomey, S. L., Zaslavsky, A. M., Jha, A. K., Nakamura, M. M., Klein, D. J., et al. (2013). Pediatric readmission prevalence and variability across hospitals. JAMA, 309(4), 372–380. https://doi.org/10.1001/jama.2012.188351.
Berwick, D. M., Nolan, T. W., & Whittington, J. (2008). The triple aim: Care, health, and cost. Health Affairs, 27(3), 759–769. https://doi.org/10.1377/hlthaff.27.3.759.
Birmaher, B., Brent, D. A., & Benson, R. S. (1998). Summary of the practice parameters for the assessment and treatment of children and adolescents with depressive disorders. Journal of the American Academy of Child and Adolescent Psychiatry, 37(11), 1234–1238. https://doi.org/10.1097/00004583-199811000-00029.
Bryan, M., Desai, A., Wilson, L., Wright, D., & Mangione-Smith, R. (2017). Association of Bronchiolitis clinical pathway adherence with length of stay and costs. Pediatrics, 139(3), e20163432. https://doi.org/10.1542/peds.2016-3432.
Buntin, M. B., & Zaslavsky, A. M. (2004). Too much ado about two-part models and transformation? Comparing methods of modeling Medicare expenditures. Journal of Health Economics, 23, 525–542. https://doi.org/10.1016/j.jhealeco.2003.10.005.
Bureau of Labor Statistics. (2013). Consumer Price Index. United States Department of Labor. Retrieved from http://data.bls.gov/timeseries/CUUR0000SAM2.
Calla, D., Yount, S., Rothrock, N., Gershon, R., Cook, K., Reeve, B., et al. (2007). The patient-reported outcomes measurement information system (PROMIS): Progress of an NIH cooperative group during its first two years. Medical Care, 45(5 Suppl 1), S3–S11. https://doi.org/10.1097/01.mlr.0000258615.42478.55.
Chassin, M. R., Brook, R. H., Park, R. E., Keesey, J., Fink, A., Kosecoff, J., et al. (1986). Variations in the use of medical and surgical services by the Medicare population. New England Journal of Medicine, 314(5), 285–290. https://doi.org/10.1056/NEJM198601303140505.
Cheung, A. H., Zuckerbrot, R. A., Jensen, P. S., Ghalib, K., Laraque, D., Stein, R. E., & GLAD-PC Steering Group (2007). Guidelines for adolescent depression in primary care (GLAD-PC): II. Treatment and ongoing management. Pediatrics, 120(5), e1313–e1326. https://doi.org/10.1542/peds.2006-1395.
Coffey, R. J., Richards, J. S., Remmert, C. S., LeRoy, S. S., Schoville, R. R., & Baldwin, P. J. (1992). An introduction to critical paths. Quality Management in Health Care, 1(1), 45–54. Retrieved from http://journals.lww.com/qmhcjournal/pages/default.aspx.
Cohen, E., Barry, J. G., Camacho, X., Anderson, G., Wodchis, W., & Guttmann, A. (2012). Patterns and costs of health care use of children with medical complexity. Pediatrics, 130(6), e1463–e1470. https://doi.org/10.1542/peds.2012-0175.
Desplenter, F. A., Laekeman, G. M., & Simoens, S. R. (2009). Pathway for inpatients with depressive episode in Flemish psychiatric hospitals: A qualitative study. International Journal of Mental Health Systems, 3(1), 23. https://doi.org/10.1186/1752-4458-3-23.
Drummond, M., Sculpher, M., Claxton, K., Stoddart, G., & Torrance, G. (2015). Using clinical studies as vehicles for economic evaluation. In Methods for the economic evaluation of health care programmes (4th edn., pp. 267–310). New York, NY: Oxford University Press.
Emmerson, B., Frost, A., Fawcett, L., Ballantyne, E., Ward, W., & Catts, S. (2006). Do clinical pathways really improve clinical performance in mental health settings? Australasian Psychiatry, 14(4), 395–398. https://doi.org/10.1111/j.1440-1665.2006.02311.x.
Erford, B. T., Erford, B. M., Lattanzi, G., Weller, J., Schein, H., Wolf, E., et al. (2011). Counseling outcomes from 1990 to 2008 for school-age youth with depression: A meta-analysis. Journal of Counseling & Development, 89(4), 439–457. https://doi.org/10.1002/j.1556-6676.2011.tb02841.x.
Evans-Lacko, S. E., Jarrett, M., McCrone, P., & Thornicroft, G. (2008). Clinical pathways in psychiatry. British Journal of Psychiatry, 193(1), 4–5. https://doi.org/10.1192/bjp.bp.107.048926.
Greenham, S. L., & Bisnaire, L. (2008). An outcome evaluation of an inpatient crisis stabilization and assessment program for youth. Residential Treatment for Children & Youth, 25(2), 123–143. Retrieved from http://www.tandfonline.com/toc/wrtc20/current.
Hazell, P. (2003). Depression in children and adolescents. American Family Physician, 67(3), 577–579. Retrieved from http://www.aafp.org/journals/afp.html.
Henken, T., Huibers, M. J., Churchill, R., Restifo, K. K., & Roelofs, J. J. (2007). Family therapy for depression. Cochrane Database of Systematic Reviews, 2007(3), 1–27. https://doi.org/10.1002/14651858.CD006728.
Hostetter, M., & Klein, S. (2012). Using patient-reported outcomes to improve health care quality. Quality matters. The Commonwealth Fund. Retrieved from http://www.commonwealthfund.org/Newsletters/Quality-Matters/2011/December-January-2012/In-Focus.aspx.
Jorm, A. F., Morgan, A. J., & Hetrick, S. E. (2008). Relaxation for depression. Cochrane Database of Systematic Reviews, 2008(4), 1–53. https://doi.org/10.1002/14651858.CD007142.pub2.
Larun, L., Nordheim, L., Ekeland, E., Hagen, K., & Heian, F. (2006). Exercise in prevention and treatment of anxiety and depression among children and young people. Cochrane Database of Systematic Reviews, 2006(4), 1–38. https://doi.org/10.1002/14651858.CD004691.pub2.
Lion, L., Wright, D., Spencer, S., Zhou, C., Del Beccaro, M., & Mangione-Smith, R. (2016). Standardized clinical pathways for hospitalized children and outcomes. Pediatrics, 137(4), e20151202. https://doi.org/10.1542/peds.2015-1202.
Lock, J. (1999). How clinical pathways can be useful: An example of a clinical pathway for the treatment of anorexia nervosa in adolescents. Clinical Child Psychology and Psychiatry, 4(3), 331–340. Retrieved from http://journals.sagepub.com/loi/ccp.
Manning, W. G., & Mullahy, J. (2001). Estimating log models: To transform or not to transform? Journal of Health Economics, 20, 461–494. Retrieved from https://www.journals.elsevier.com/journal-of-health-economics.
Mittal, V., Darnell, C., Walsh, B., Mehta, A., Badawy, M., Morse, R., et al. (2014). Inpatient Bronchiolitis guideline implementation and resource utilization. Pediatrics, 133(3), e730–e737. https://doi.org/10.1542/peds.2013-2881.
Nakanishi, M., Sawamura, K., Sato, S., Setoya, Y., & Anzai, N. (2010). Development of a clinical pathway for long-term inpatients with schizophrenia. Psychiatry and Clinical Neurosciences, 64(1), 99–103. https://doi.org/10.1111/j.1440-1819.2009.02040.x.
National Collaborating Centre for Mental Health. (2010). Depression: The treatment and management of depression in adults (updated edition). Leicester: British Psychological Society and The Royal College of Psychiatrists.
National Guideline Clearinghouse. (2010). Best evidence statement (BESt): Screening of children and adolescents for major depressive disorder (MDD). Retrieved from http://www.ngc.gov/content.aspx?id=16308&search=major+depression.
New Zealand Ministry of Health. (2008). Identification of common mental disorders and management of depression in primary care. An evidence-based practice guideline. Wellington, NZ: New Zealand Guidelines Group. Retrieved from http://www.health.govt.nz/publication/identification-common-mental-disorders-and-management-depression-primary-care.
Rotter, T., Kinsman, L., James, E., Machotta, A., Gothe, H., Willis, J., et al. (2010). Clinical pathways: Effects on professional practice, patient outcomes, length of stay and hospital costs. Cochrane Database of Systematic Reviews, 2010(7), 1–121. https://doi.org/10.1002/14651858.CD006632.pub2.
Simon, T. D., Berry, J., Feudtner, C., Stone, B. L., Sheng, X., Bratton, S. L., et al. (2010). Children with complex chronic conditions in inpatient hospital settings in the United States. Pediatrics, 126(4), 647–655. https://doi.org/10.1542/peds.2009-3266.
Simon, T. D., Cawthon, M. L., Stanford, S., Popalisky, J., Lyons, D., Woodcox, P., et al. (2014). Pediatric medical complexity algorithm: A new method to stratify children by medical complexity. Pediatrics, 133(6), e1647–e1654. https://doi.org/10.1542/peds.2013-3875.
StataCorp. (2011). Stata statistical software: Release 12. College Station, TX: StataCorp LP.
Stephen, A. E., & Berger, D. L. (2003). Shortened length of stay and hospital cost reduction with implementation of an accelerated clinical care pathway after elective colon resection. Surgery, 133(3), 277–282. https://doi.org/10.1067/msy.2003.19.
Sylvester, A. M., & George, M. (2014). Effect of a clinical pathway on length of stay and cost of pediatric inpatient asthma admissions: An integrative review. Clinical Nursing Research, 23(4), 384–401. https://doi.org/10.1177/1054773813487373.
Tarin, T., Feifer, A., Kimm, S., Chen, L., Sjoberg, D., Coleman, J., & Russo, P. (2014). Impact of a common clinical pathway on length of hospital stay in patients undergoing open and minimally invasive kidney surgery. The Journal of Urology, 191(5), 1225–1230. https://doi.org/10.1016/j.juro.2013.11.030.
Todd, J., Armon, C., Griggs, A., Poole, S., & Berman, S. (2006). Increased rates of morbidity, mortality, and charges for hospitalized children with public or no health insurance as compared with children with private insurance in Colorado and the United States. Pediatrics, 118(2), 577–585. https://doi.org/10.1542/peds.2006-0162.
US Preventive Services Task Force. (2009). Screening and treatment for major depressive disorder in children and adolescents: US Preventive Services Task Force recommendation statement. Pediatrics, 123(4), 1223–1228. https://doi.org/10.1542/peds.2008-2381.
Varadhan, K. K., Neal, K. R., Dejong, C. H., Fearon, K. C., Ljungqvist, O., & Lobo, D. N. (2010). The enhanced recovery after surgery (ERAS) pathway for patients undergoing major elective open colorectal surgery: A meta-analysis of randomized controlled trials. Clinical Nutrition, 29(4), 434–440. https://doi.org/10.1016/j.clnu.2010.01.004.
Welch, W. P., Miller, M. E., Welch, H. G., Fisher, E. S., & Wennberg, J. E. (1993). Geographic variation in expenditures for physicians’ services in the United States. New England Journal of Medicine, 328(9), 621–627. https://doi.org/10.1056/NEJM199303043280906.
Williams, S. B., O’Connor, E. A., Eder, M., & Whitlock, E. P. (2009). Screening for child and adolescent depression in primary care settings: A systematic evidence review for the US Preventive Services Task Force. Pediatrics, 123(4), e716–e735. https://doi.org/10.1542/peds.2008-2415.
Zuckerbrot, R. A., Cheung, A. H., Jensen, P. S., Stein, R. E., & Laraque, D. (2007). Guidelines for adolescent depression in primary care (GLAD-PC): I. Identification, assessment, and initial management. Pediatrics, 120(5), e1299–e1312. https://doi.org/10.1542/peds.2007-1144.
Funding
Funding for this project was provided by a grant from the University of Washington School of Medicine Medical Student Research Training Program (MSRTP), no official Grant Number provided.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
The authors declare that they have no conflict of interest.
Ethical Approval
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
Informed Consent
Informed consent was obtained from all individual participants included in the study.
Rights and permissions
About this article
Cite this article
Lifland, B., Wright, D.R., Mangione-Smith, R. et al. The Impact of an Adolescent Depressive Disorders Clinical Pathway on Healthcare Utilization. Adm Policy Ment Health 45, 979–987 (2018). https://doi.org/10.1007/s10488-018-0878-6
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10488-018-0878-6