Page 176 - 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

care utilizations among patients undergoing a thyroidectomy. In Section 3, we present
the results from statistical analyses. Also, we employ the Difference-in-differences (DID)
approach to address the potential endogeneity issue for robustness check. Section 4
provides the interpretation of our findings within the context of the wider literature as well

as the implications for health policy and clinical practice. Lastly, we draw conclusions in
Section 5.

2. Methods

2.1 Study Population
This is a retrospective observational study where the research subjects are
patients who received thyroidectomies in a specified medical center and whose disease

manifestations met the requirements of the case payment system. We collect the data
between January 2001 and December 2003 since the CPs have been implemented
during this period. In total, we recruit 381 patients, all receiving surgical interventions
corresponding to the procedural codes of the International Classification of Diseases,

Ninth Revision (ICD-9), where unilateral thyroid lobectomy (ICD-9: 06.2), partial
thyroidectomy (ICD-9: 06.39), or TT (ICD-9: 06.4) are the primary diagnoses. To avoid
analytical bias, we exclude surgeons who performed fewer thyroidectomy surgeries,
because the number of surgeons may have an effect on clinical and financial outcomes

(Al-Qurayshi, Robins, Hauch, Randolph, and Kandil, 2016). Thus, we consider three GS
surgeons to be outliers because each of them performed no more than two thyroidectomy
surgeries in the three sample years (2001-2003). Accordingly, we exclude five patients
who are operated on by these three GS surgeons. Among these five exclusions, four

surgeries are performed before the implementation of the CPs by two GS surgeons (each
surgeon performs the thyroidectomy surgery twice), while one GS surgeon performs the
surgery after the implementation of CPs. The final sample thus consists of 376 patients.
There are 143 patients having the thyroidectomy performed by GS doctors before the CPs’

implementation from January 2001 to June 2002, and 149 patients getting the surgeries
after the CPs’ implementation from July 2002 to December 2003. There are a total of 84
thyroidectomies performed by ENT doctors without adopting the CPs, of which 45 take

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