Page 174 - 臺大管理論叢第33卷第1期

The Effect of Applying Clinical Pathways on Medical Resource Utilization among Patients Undergoing a
Thyroidectomy

are defined as structured multidisciplinary care plans which detail essential steps for the
care of patients with a specific clinical problem or with a similar diagnosis, procedure, or
symptom during a well-defined period of time (De Bleser et al., 2006; Rotter, Kinsman,
James, Machotta, Willis, Snow, and Kugler, 2012). Previous research on the quality of

cancer care, guidelines and CPs has demonstrated improvements in compliance with
guidelines and evidence-based medicine, as well as reductions in the length of hospital
stays, complication rates and financial costs (Kwon, Lee, Woo, Lim, Moon, and Paik,

2018; van Dam, Verheyden, Sugihara, Trinh, Van Der Mussele, Wuyts, Verkinderen,
Hauspy, Vermeulen, and Dirix, 2013). To date, CPs have been implemented for a great
variety of diseases to improve the effectiveness of treatment and lower costs.
The objective of this study is to assess the effect of CPs on medical resource
utilization by comparing the costs and Length of Stay (LOS) for patients undergoing a

thyroidectomy before and after the implementation of the CPs, and among the different
divisions and surgeons performing the thyroidectomy. To the best of our knowledge, none
of the recent efforts have evaluated the effect of CPs on medical resource utilization in

thyroidectomy by different surgeons. The reasons for comparing patients undergoing a
thyroidectomy involving different surgeons, i.e., General Surgeons (GS) and Ear, Nose,
and Throat (ENT) doctors, are as follows.
Traditionally, thyroidectomy operations have been conducted by general surgeons.
However, with the advances in the medical domain and medical specialties and

subspecialties becoming exhaustive, it has become common for the ENT doctor to perform
a thyroidectomy. At present, according to the case-payment items stipulated by the NHIA
in Taiwan, a thyroidectomy comes under the GS category. However, if the principal

procedural codes of the thyroidectomy correspond with the primary declaration, every
division in the hospital can declare the expenditure. This may result in different procedures
and different medical costs for different surgeons, which may in turn lead to potential
disparities for patients in the allocation of healthcare resources.
Over the last few decades, the incidence of thyroid cancer has gradually increased

in numerous countries and regions worldwide (Li, Dal Maso, and Vaccarella, 2020). In
2020, according to the Taiwan Cancer Registry, thyroid cancer was ranked 8 among the
th
various cancers. The age-standardized incidence rate of thyroid cancer is 13.1 per 100,000

people, involving a total of 4,053 patients (Health Promotion Administration, Ministry

166