• Yuko Mine, Yoshihisa Fujino, Ken Sabanai, Keiji Muramatsu, Makoto Otani, Tatsuhiko Kubo, Kiyohide Fushimi, and Shinya Matsuda.
• Department of Preventive Medicine and Community Health, School of Medicine, University of Occupational and Environmental Health, 1-1, Iseigaoka, Yahatanishiku, Kitakyushu, 807-8555, Japan; Secretariant of Japanese Physical Therapy Association, 3-8-5, Sendagaya, Shibuyaku, Tokyo, 151-0051, Japan. Electronic address: yuuko-mine@med.uoeh-u.ac.jp.
• J Orthop Sci. 2020 Jan 1; 25 (1): 127-131.

BackgroundRegional clinical pathways, a new type of clinical pathway, are practiced with the aim of standardizing and optimizing medical care by cooperation among multiple medical institutions in a region. However, current evaluation of the effectiveness of regional clinical pathways for hip fracture, a major health problem requiring hospitalization for orthopedic surgery, is insufficient. This study aimed to determine the association between regional clinical pathways and postoperative hospital length of stay (LOS) among hip fracture patients. In particular, we focused on the variation in postoperative LOS of hip fracture patients among hospitals and the contribution of regional clinical pathways to this variation.MethodsUsing data from the Diagnosis Procedure Combination (DPC) database in Japan from April 2011 to March 2013, patients who were diagnosed with "fracture of head and neck of femur" (ICD10 code S72.0) or "pertrochanteric fracture" (S72.1) and received "bipolar hip arthroplasty" or "open reduction and internal fixation" were extracted. A total of 110,133 patients were included. Associations between regional clinical pathways and postoperative LOS were analyzed using cross-sectional analysis with multilevel regression models.ResultsHospitals that implemented a regional clinical pathway showed a significant reduction (13 days) in the postoperative LOS of hip fracture patients. We found a 16% inter-hospital variation in postoperative LOS, which might be explained by hospital-level implementation of regional clinical pathways. Application of regional clinical pathways at the patient level resulted in a 4-day decrease in postoperative LOS.ConclusionsImplementation of regional clinical pathways for hip fracture patients at the hospital level was associated with reduced postoperative LOS, regardless of whether or not pathways were implemented at the patient level. This suggests that regional clinical pathways are effective for patient care management in hospitals.Copyright © 2019 The Japanese Orthopaedic Association. Published by Elsevier B.V. All rights reserved.

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