Web-based Clinical Pathway for Reducing Practice Variations in Radical Prostatectomy Yu-Chao Hsu 1 , MD; Ke-Hung Tsui 1 , MD; Chien-Lun Chen 1 , MD; Sheng-Hui Lee 1 , MD; Ya-Shen Wu 1 , MD; Phei-Lang Chang 1,2,3 , MD Background: A clinical pathway support system on the Internet (CPSSI) has been designed for creating and implementing a web-based clinical pathway for radical prostatectomy. This investigation assessed the effects of the web- based clinical pathway for radical prostatectomy on practice variations. Methods: From June 2002 to Jun 2003, 22 consecutive patients with localized prostate cancer who underwent radical prostatectomy were treated according to the web-based clinical pathway. The treatment results were compared with an identically sized sample of patients treated during the year before implement- ing the web-based clinical pathway. Variations before and following the implementation of the web-based clinical pathway for radical prostatectomy were also assessed. The CPSSI automatically measured pathway variations and length of hospital stay. Results: After implementing the web-based clinical pathway, the average hospital stay was reduced significantly (p = 0.0001). The mean number of variations also differed markedly (p = 0.0002). Conclusion: This study concludes that the CPSSI-based clinical pathway support system may provide a good tool for creating and implementing a web-based clinical pathway. After implementing the web-based clinical pathway for radical prostatectomy, practice variations and length of stay were reduced consider- ably. Moreover, automatically assessing the effects of web-based clinical pathway implementation can enhance the quality of patient care. (Chang Gung Med J 2008;31:567-75) Key words: web-based, clinical pathway, decision support system, health outcome From the 1 Division of Urology, Department of Surgery; 2 Chang Gung Bioinformatics Center, Chang Gung Memorial Hospital, Taipei, Chang Gung University College of Medicine, Taoyuan, Taiwan; 3 Graduate Institute of Biomedical Informatics, Taipei Medical University, Taipei, Taiwan. Received: Jul. 10, 2007; Accepted: Jan. 30, 2008 Correspondence to: Dr. Phei-Lang Chang, Department of Urology, Department of Surgery, Chang Gung Memorial Hospital. 5, Fusing St., Gueishan Township, Taoyuan County 333, Taiwan (R.O.C.) Tel.: 886-3-3281200 ext. 2137; Fax: 886-3-3274541; E-mail: henryc@cgmh.org.tw T he web is used as a tool to communicate infor- mation among physicians, nurses and patients. (1) Recent studies have reported good results for web- based surveys, clinical monitoring systems, and dis- tance medical education programs. (2-4) In clinical process management, implementation of web-based clinical pathways has been reported to exhibit good results that are more accurate than paper-based path- ways in detecting variances. (5) The implementation of clinical pathways has been used to monitor health outcomes and also to improve the quality of patient care. (6,7) Physicians, administrators and nurses, as well as patients and their families, have all contributed to formulating 567 Original Article