Analysis Of Clinical Pathway Compliance In Arthroplasty Cases At Secondary Referral Hospitals In South Sulawesi

Abstract

Background:

Clinical pathways (CPs) are structured, evidence-based multidisciplinary care plans designed to standardize medical management, improve clinical outcomes, and optimize healthcare efficiency. In Indonesia, CPs are aligned with the National Health Insurance system and the INA-CBGs payment model, requiring hospitals to ensure cost-effective and high-quality care. Arthroplasty procedures, often associated with substantial clinical and financial burdens, benefit from CP implementation. However, data on CP compliance, particularly in secondary referral hospitals in South Sulawesi, remain limited. Evaluating CP adherence in arthroplasty cases is essential to assess its impact on patient outcomes and healthcare costs.

Objective:

To evaluate the level of compliance with clinical pathways in arthroplasty procedures at a secondary referral hospital and to analyze its impact on patient outcomes and medical service costs.

Methods:

This was a cross-sectional analytical study using retrospective data from 75 patients who underwent arthroplasty procedures at Hasanuddin University Hospital between November 2019 and May 2024. Compliance with clinical pathway indicators—including medical assessment, diagnostic tests, procedures, medication, pharmaceutical assessment, rehabilitation, consultation, and discharge planning—was evaluated using electronic medical records. Data were analyzed using descriptive statistics and chi-square tests to assess the relationship between pathway compliance and medical costs.

Results:

Of the 75 arthroplasty cases analyzed, full compliance with all clinical pathway indicators was observed in 38.7% of patients, while 61.3% showed non-compliance. Diagnostic tests, medication, pharmaceutical assessment, rehabilitation, and consultation indicators had 100% compliance. However, lower compliance was noted in medical assessment (38.7%), medical procedures (72%), and discharge planning (61.3%). A significant association was found between pathway compliance and medical service costs, with non-compliance linked to higher costs (p < 0.0005).

Conclusion:

Adherence to clinical pathways in arthroplasty cases is associated with reduced length of stay and lower medical service costs. While several indicators demonstrated full compliance, gaps remain in medical assessment, procedures, and discharge planning. Strengthening pathway implementation can enhance care quality and cost-efficiency in secondary referral hospitals.