Web-based clinical pathway for reducing practice variations in radical prostatectomy.

Background: A clinical pathway support system on the Internet (CPSSI) has been designed for creating and implementing a web-based clinical pathway for radical prostatectomy. This investigation assessed the effects of the webbased clinical pathway for radical prostatectomy on practice variations. Methods: From June 2002 to Jun 2003, 22 consecutive patients with localized prostate cancer who underwent radical prostatectomy were treated according to the web-based clinical pathway. The treatment results were compared with an identically sized sample of patients treated during the year before implementing the web-based clinical pathway. Variations before and following the implementation of the web-based clinical pathway for radical prostatectomy were also assessed. The CPSSI automatically measured pathway variations and length of hospital stay. Results: After implementing the web-based clinical pathway, the average hospital stay was reduced significantly (p = 0.0001). The mean number of variations also differed markedly (p = 0.0002). Conclusion: This study concludes that the CPSSI-based clinical pathway support system may provide a good tool for creating and implementing a web-based clinical pathway. After implementing the web-based clinical pathway for radical prostatectomy, practice variations and length of stay were reduced considerably. Moreover, automatically assessing the effects of web-based clinical pathway implementation can enhance the quality of patient care. (Chang Gung Med J 2008;31:567-75)