The Study On Effect Of Clinical Pathway In Tangshan Union Hospital

ObjectivesClinical Pathway (CP) is a standardized medical and nursing scheme to a special disease or case, and this scheme have rational, effective safe and effective service process and the content to most of patients who have one disease. Tangshan Union Hospital will implementation standardization management in hospital and the clinical pathway is an important part.To evaluate efficiency of clinic pathway conducted in monopathy quality control based on the analyses of recorded data involving clinic pathway management in monopathy quality control in a hospital and find out the existing problems, and give some suggestions for the total quality management in hospital.Methods1. Materials: the study collects from record room and computer room of the Tangshan Union Hospital, collects disease documents and medical expenditure lists of acute appendicitis operation, deviation of nasal septum, ovarian cyst, adenoid vegetation were managed as a trial group with clinic pathway between January 1, 2010 and December 31, 2010, and the patients with same diseases and comparable features were managed as a control group without clinic pathway between January 1, 2009 and December 31, 2009. All the data including information about patient's hospitalization record, the times in hospital, patient's name, gender, nationality, age, disease name, situation on admission, time of discharging, situation on discharging, hospital days, cost of hospitalization drug expense ,checking , treatment and operations expenses. The comparing indexes were patient's name, gender, nationality, age, disease name, and prognosis of disease. The evaluating outcomes indexes including hospital days cost of hospitalization and drug, checking, treatment and operations expenses.2 Research Methods:2.1 Literature Method: Search for information about the domestic and foreign related literature by internet net work tools such as CNKI, relevant professional journals and books, collecting the domestic and foreign present situation, selection principle of the application of the clinical pathway and the reference about cost control.2.2 Panel Discussion: The study organized the experts in clinical, financial , medical and education department to discuss the standard and method to measure the expenditure of single diseases., then combined with the leader of doctor and nurse of clinic department, make sure the last pathway.2.3 Health Economics Analysis: Compare the component and diversity of the expenditure between before and after CP.2.4 Statistical Analysis: Build the database by Microsoft Office Excel2003 and adopt SPSS13.0 analysis software for medical expenses the factors affecting the descriptive statistical analysis. The frequency of counting material a statistical description, hypotheses test adopted a chi-square test.Research Contents1. Account the expenditure of CP: Carry through study based on CP, analyze the component of the single diseases expenditure, account the expenditure of CP from the aspects of the hospital days, check-up item, medicine item, therapy item and operation item.2. Compare average hospital stay, the component and difference. Compare average hospital stay, the component and difference. Compare average hospital stay of the single diseases expenditure between before and after CP, analyze the key tache of CP, and find out the effective factors of single diseases expenditure after CP.3. Offer practical methods to control the medical expenditure and medical quality management: Evaluate the circs of carrying CP into execution, using the indexes of the hospital days, the medical expenditure and the component ratio of druggery fees. Find out the issues existing in the process of carrying CP into execution, and offer corresponding strategies to control the expenditure.Result1. 409 patients of 3 diseases in the trial group with clinic pathway were hospitalized between January,1 2010 and December,31 2010, and 485 patients with same diseases in the control group were recruited between January,1 2009 and December,31 2009. The basic characteristics such as gender, nationality, age, situation on admission between groups were without statistically difference (p>0.05).2.Compared to control group, the results showed that the average hospital days in 2 disease patients decreased, only Uterine fibroids patient's average hospital days were without statistically difference(P>0.05).3. Compared to control group, the results showed that the cost of hospitalization had decreased. Only average cost of hospitalization of acute appendicitis patient didn't decrease obviously, it was without statistically difference(P>0.05).Conclusion1.From our study sample of the 3 monopathies, we concluded that clinic pathway was a helpful model to shorten the average hospital days, and to reduce the drug expense of patients of acute appendicitis. The results implied that clinic pathway management model plays an important role in the quality management of the monopathy medical services.2.The hospital should execute and spread CP strictly, constitute scientific and reasonable supervise system on CP, inspect the disease document termly and evaluate the effect of CP.3. While the director of hospital carried out the CP, only have initiative spirit, sufficient demonstration, provide training, reasonable arrangement, Clinical pathway to bring into full play the positive role in the hospital management.