Page 180 - 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

indicates that any observed differences in CCI scores among these groups are considered
to be due to chance or random factors. It can be seen from Table 1 that not only the
observed average CCI scores of GS patients decrease, but the average CCI scores of ENT
patients also decrease after the CPs’ implementation. However, the insignificant results

do not permit the rejection of the null hypothesis of equal means. Similarly, despite the
CCI scores of ENT thyroidectomy patients being higher than those of GS thyroidectomy
patients both before and after CPs’ implementation, the differences are not statistically

significant. In other words, our sample does not provide sufficient evidence to infer that
there are differences in CCI scores among patients in the different groups.
Conversely, there is a significant difference (p < 0.001) in three major clinical
interventions, i.e., unilateral thyroid lobectomy (ICD-9-CM: 06.2), partial thyroidectomy
(ICD-9-CM: 06.39), and TT (ICD-9-CM: 06.4). The ENT group has the highest percentage

of partial thyroidectomy in the current medical center both before and after the CPs’
implementation. The post hoc test results indicate that the ENT group differs significantly
from the GS group both before and after the implementation of CPs (p < 0.001).

In regard to the results of the post hoc tests between the GS-BCP group and GS-
ACP group, the average LOS falls from 3.73 to 2.54 days after the CPs’ implementation,
exhibiting a decrease of 1.19 days (p < 0.01). Similarly, the comparison between the
GS-ACP group and the ENT group (where the CPs are not implemented) shows that the
LOS for the GS-ACP group is 2.84 days shorter than that for the ENT group, exhibiting

a significant difference of 52.79% (p < 0.001). Furthermore, the average total hospital
charges are NT$38,232 and NT$32,505 for the GS-BCP group and GS-ACP group,
respectively. This implies that after the CPs’ implementation, each thyroidectomy results

in a saving of NT$5,727 on average, representing a 14.98% decrease (p < 0.01). In
addition, the hospital charges for the GS-ACP group are NT$5,123 less than those for the
ENT group (p < 0.001).
Finally, the results of the post hoc tests indicate that there is no significant difference
between the ENT-BCP and ENT-ACP groups except for the major clinical interventions,

patient age and gender. The ENT-ACP group has a higher proportion of female patients (p
= 0.036) and partial thyroidectomies (p = 0.018) than the ENT-BCP group. Patients in the
ENT-ACP group are older than those in the ENT-BCP group (p = 0.045).

The details for hospital charges are further split into several fee items to examine

172