心不全例におけるカルベジロール導入クリティカルパスの有用性

Effectiveness of the Critical Path for Administering Carvedilol in Patients with Congestive Heart Failure

要旨　【目的】クリティカルパスは治療手技の標準化，入院期間の適正化に有用な手段とされる．心不全入院例でのパス使用下β遮断薬導入の有用性を検討する．【方法】カルベジロール導入を行った51例を，パス使用群22例(P群)とパス非使用群29例(C群)に分けた．両群間で入院期間，入院費用などを比較し，入院期間に関連する因子の検討を行った．【結果】P群にて，入院期間(20.2±9.7 vs 34.3±12.0，p＜0.0001；P群 vs C群，Mean±SD)，カルベジロール開始後入院期間(12.8±3.6 vs 23.4±11.8，p＜0.0001)は有意に短く，総入院費用(77,311±39,161 vs 110,693±52,742，p＜0.05)は低い．最終カルベジロール用量(10.6±5.1 vs 9.6±4.4)には差はなかった．重回帰分析ではパスの有無のみが入院期間に関連する有意な説明因子であった．【結語】心不全患者へのカルベジロール導入パスは費用負担の軽減と入院期間の短縮に寄与する有用な手段である．

　The critical path, which used a multidisciplinary team approach, included an intensive education program. The aim of this study was to evaluate the effect of administration of carvedilol critical path on length of stay and hospital cost. METHODS: We studied 51 patients at admission for CHF and started the carvedilol from September, 2001 to March, 2007. These patients were divided into the post-implementation of the critical path(Path group: P)(22 patients) and the pre-implementation of the critical path(Control group: C)(29 patients). The carvedilol was commerced, using the critical path for patients in the P group and using the traditional practice in the C group. The predictors of length of hospital stay were evaluated by multiple regression analysis. RESULTS: Baseline characteristics of the two groups were similar. The use of the path revealed significant decreases in length of hospital stay(20.2±9.7 vs. 34.3±12.0, p＜0.0001), length of stay from starting carvedilol(12.8±3.6 vs. 23.4±11.8, p＜0.0001), and hospital cost(77,311±39,161 vs. 110,693±52,742, p＜0.05) in the P and C group, respectively. The use of the path was the only independent predictor of length of hospital stay. CONCLUSION: The critical path for administering carvedilol can decrease length of stay and hospital cost.