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

healthcare utilization are influenced by implementing the CPs, it is possible that other
unmeasured factors also have an effect. For example, one concern is that surgeons
may tend to select patients with lower disease severity and less complicated surgical
procedures to enter the thyroidectomy CPs, thereby amplifying the advantages and effects

of CPs. Nevertheless, there is no statistically significant difference between the GS and
ENT groups according to the CCI scores. In addition, the major diagnostic categories
that represent different disease severity and surgical procedures are also insignificant

between the GS and ENT groups. Moreover, from the regression results, there is no
significant impact of the age and years of service of the surgeons on the LOS and medical
expenditure. Therefore, in the current retrospective study, it is highly unlikely that the
surgeons will tend to select those patients with a lower severity of illness or who can be
operated on with less complicated surgical procedures to enter the thyroidectomy CPs.

Nevertheless, whether or not CPs have an impact on the provider’s behavior and quality of
care still needs further investigation.

5. Conclusion

This study demonstrates the importance of medical cost control on thyroid
surgery under the case payment system. Overall, we show that the implementation of
CPs improves the consistency of treatment among patients, enhances the quality of

patient prognosis, reduces the costs of nursing care and LOS, and significantly lowers
hospitalization expenditures. The CPs not only improve hospital finances but also further
provide realistic benefits in terms of improved medical care quality, which is achieved
through the joint efforts of physicians, nurses and other medical professionals who work

together to develop clinical or care guidelines for the CPs. Facing the challenges from
the case payment or the Taiwan Diagnosis Related Group System (Tw-DRGs), hospital
managers should support the involvement and collaboration of medical staff in developing
CPs for each specific case payment category to standardize intervention procedures as well

as to reduce variability in medical care quality. Further research is warranted to investigate
the cost-effectiveness of CPs’ implementation and the potential risk of cost shifting from
the inpatient to outpatient departments.

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