| BackgroundNowadays, the government of different countries and people pay more attention to the increasing consumption of healthcare resources and the requirement of quality of healthcare delivery with the continuant development of medical science and the growing demand about medical services. Accordingly, how to provide and conduct better healthcare services with higher quality, lower expenses and more efficiency have become major challenges, which are big problems to the health officials around the world, especially during the transition period of health system reform in China.Clinical pathway (CP), with both technology and management characteristics at the same time, means to an optimal, simplified and synergistic management pattern especially for disease management, which works through the collaboration of multi-disciplines, construct standardized operation procedures to guide practitioners'medical behaviors. It clarifies the routine procedure of healthcare technique and provides the approach, methods and basic standard to realize the expected goals for better healthcare. By using the clinical pathway, patients will gain benefit of shortening average hospital stays and lower expenditure so as to decrease waste of limited medical resources and to optimize the effect of medical treatment.Clinical pathway has been used in only a few hospitals since it was introduced into China in 1990's. However, China's Ministry of Health and the State Administration of Chinese Medicine proposed to establish and carry out clinical pathway to help to relieve the problems of deficiency of medical resources and excessive health care cost.In this study, the author analyzed and summarized the history, definition, basic theory of clinical pathway, tried to establish the guidelines, to deal with key issues and the measurement, and to propose a structured reporting of evidence-based Chinese clinical pathway, in order to contribute to the development of methodology about Chinese clinical pathway as an example for the relevant institution and officials.Objectives1 Try to provide the scientific evidence for the spread and exploitation of evidence-based Chinese medical pathway by analyzing its basic theory from the view of multi-disciplines.2 Try to establish the evidence-based, systematic and scientific methodology structure of clinical pathway including how to design, measure, appraise and report clinical pathway for a certain disease, which should embody the characteristics of Chinese medicine.3 Try to propose strategies for resolution of the difficulties and key issues in designing an evidence-based Chinese medicine pathway by analyzing the experience of preliminary application in clinical practice.MethodsThis study defined the clinical pathway, and stated the basic principles and methods for developing a clinical pathway by synthesizing the published literatures systematically, compared the difference between clinical pathway and clinical practice guideline, and compared the differences and analyzed the interaction between the management model based on clinical pathway methodology and the concept and the model based on traditional methodology.According to the theory of development of clinical pathway, two independent case studies-in application of the clinical pathway for two conditions including sudden deafness and chronic heart failure, were carried out to help to explore the possible basic theory of evidence-based Chinese clinical pathway, and raise the procedures on developing and practicing the evidence-based Chinese clinical pathway, also discuss the difficulties, key issues and the solution during the process of pathway development to format the evidence-based Chinese clinical pathway report guidelines, by different quantitative and qualitative data collecting methods such as in depth-interviewing, analyzing, deep describing, inducing and deducing, group consensus et al.FindingsIn the literature review, we introduced the history and theory of clinical pathway development, and clarified its internal and external implications. Also we compared the difference between the clinical pathway and clinical practice guideline, and analyzed the difference and interaction between the management model based on clinical pathway methodology and concepts and the model based on traditional methodology.In the methodology study, we analyzed the importance and necessity to apply the clinical pathway into the evidence-based Chinese clinical practice. And we elaborated the details about how to construct the clinical pathway for evidence-based Chinese medicine. The process included:the constitution and responsibility of the team for developing clinical pathway; criteria for selecting diseases for clinical pathway, and analyzing the feasibility; drafting the relevant management documentations and determining relevant stuffs'duty; searching and appraising literatures; making schedules; designing the clinical pathway contents; consulting the experts; training the relevant practitioners and nurses.And we also elaborated the details about how to implement the clinical pathway of evidence-based Chinese medicine. The process includes:setting up inclusion criteria and exclusion criteria; keeping recording the process of treatment; recording of its implementation, analyzing and solving the possible deviations from pathway; collecting and classifying the patients'outcomes.Accordingly, the scientific and rationality process of developing clinical pathway, detecting and analyzing deviations, appraising the implementation and efficiency as well as performance reports should be listed on the appraisal program of the evidence-based Chinese clinical pathway.The difficulties of developing the clinical pathway of evidence-based Chinese medicine included:classifying the TCM treatment strategy, the outcomes of Chinese medicine treatment, choosing and making decisions based on available evidence. And the key issues included:collecting the evidence, identifying the advantages, and reaching experts consensus. Furthermore, the main structure for writing evidence-based Chinese clinical pathway should include introduction, contents, references, attachments, and other in total of 18 items.ConclusionsThis finding from this study suggests:1 It would be very meaningful to construct and practice the evidence-based Chinese clinical pathway in order to improve healthcare quality and strength the position of Chinese medicine treatment for the patients'healthcare services.2 It would be very important to construct and form the evidence-based Chinese clinical pathway based on the perspectives of humanity, the theory and methodology of evidence-based medicine, the theory of modern management, health economic principle, and embodying characteristics of Chinese medicine.3 It would be a crucial technique to construct evidence-based Chinese clinical pathway according to the common methodology and the principles as above-mentioned, and we must pay attention to some key issues such as keeping the balance between the specialty and generalizability, using and classifying the evidence available.4 It would be necessary to propose a guide for reporting the evidence-based Chinese clinical pathway which could be modified on usage in practice.
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