Variance Analysis And Implementation Effect Of Type 2 Diabetes Clinical Pathway

Objective:This study was to analyze the status of implementation and effects of the type 2 diabetes clinical pathway, to confirm that type 2 diabetes as one chronic disease were able to managed effectively by the clinical pathway. Meanwhile, the links of variance and variance reasons of type 2 diabetes clinical pathway were analyzed, the corresponding management strategies according to the reasons were put forward, and the modle of variance management of type 2 diabetes clinical pathway was initially established to promote the variance management of clinical pathway and promote the implementation of clinical pathway in the country.Sources and Methods:This paper used secondary data analysis, field investigation, in-depth interview and so on. The clinical pathway management related rules and regulation, variation methods and indicators were collected from affiliated hospital of Jining Medical College, affiliated hospitals of Medical College Qingdao University. Meanwhile, type 2 diabetes medical records of patients were collected at the clinical pathway management pilot hostital that implemented it, and variances questionnaires were completed by looking over the medical records. In-depth interviews were done to understand the variances, problems and solutions of type 2 diabetes in the implementation of clinical pathway. A database was established By Epidata13.0. The data was combined according to hospital number. And then SPSS18.0 software was used to analyze the data. The descriptive analysis, nonparametric tests, multiple line regression analysis and correlation analysis were used to analyze of type 2 diabetes clinical pathway effects, the variances and its reasons. Then the management strategies were proposed.Results:1. Length of stay of type 2 diabetes patients with clinical pathway management was normal distribution. The average length of stay was 12.25 days. The total cost of hospitalization were skewed distribution, the median was 4773 yuan. The median of western medicine charges was 1,783 yuan, which accounted for 36% of the total cost of hospitalization.2. After the implementation of clinical path management, the number of accompanying diseases and the accompanying diseases with or not in patients hospitalized with no significant difference of length of stay. Patients with different types of Medicare had significant differences in the length of stay. Factors affecting length of stay was Medicare type, diabetic neuropathy.3. And the accompanying diseases associated with the number of hospital patients had significantly different costs. The total hospitalization cost for multiple regression analysis showed that surgery cost, medicine cost, accompanying diseases, health insurance types were the main factors.4. Varianaces of type 2 diabetes cp and its occurrence rate were: into the path varianace rate was 3%; lengh of stay varianace was 56.9%, which the positive variance was 34.7%, the negative variance was 22.2%; key treatment projects such as steamed bread + C peptide release test or 75gOGTT + C peptide release test variance was 11.4%, variance of neuropathy assessment was 90.4%, variance of foot care and guidance detection and was 4.8%; exit path was 0.6%. 5. Main causes of variances were patient's condition, patients receiving the examination or surgery or not, whether the requirements of patients discharged from hospital, health care reimbursement or not, medical staff's medical technology.All of these variance factors affected on the length of stay.6. It is important to establish the variance management of type 2 diabetes cp, draw up the process of variance management, make a clear responsibility for health care workers and form the monthly variance reporting system.Discussion:1. Through the type 2 diabetes clinical pathway, the number of accompanying diseases, the accompanying diseases with or not, health insurance types reduced the impact on lenth of stay, to a certain extent, that the clinical pathway management effectively controlled the lenth of stay.2. The path through the management of type 2 diabetes mellitus, the number of accompanyin disease, the accompanying diseases with or not, hospitalization costs associated with the disease on the impact of significantly different types of inpatient health care costs were not significantly different, which to some extent that of type 2 diabetes patients with complications are still the main factors affecting the hospitalization cost, which is consistent with other domestic literature.3. Medical personnel have not yet fully understood the variances in type 2 diabetes cp, the importance of managing the variances, the type of variances and genetic variances in vague definition content, there is variances of a single complete record incomplete, inaccurate, medical variance management initiative is not high.4. Hospital electronic medical record system for clinical pathway variance with type 2 diabetes, management of technical support, due to the current electronic medical record system and clinical pathway has not yet completed the docking and fusion, electronic medical records in the statistical analysis of the clinical use of the path variation there is insufficient information, statistics, single indicators and other issues. 5. The lack of relevant constraints and targeted incentives made the staff can not fully mobilize the enthusiasm and reduced the execution of variance management.Strategies and recommendations:1. Speed up the hospital electronic medical records and clinical pathway of the docking and fusing, increase the level of hospital information to provide technical support for the variance management of type 2 diabetes clinical pathway.2. To carry out the thematic training of variance management to clear the content and type ofvariance, holding the exchange of experience, organizing site tours, learning experience from counterparts in the variance management.3. Develop variance management measure and the inspired system, restrain action of health care workers.Make a clear incentive to improve their initiative and enthusiam.4.Probe into the links and projects in variances management of type 2 diabetes.According to the key links and projects, into path, check the test items, length of stay, adverse medical quality, exit path, hospital charges and so on are the focus of variances management.