Study On Implementation Effects Of Medical Service Management Based On Clinical Pathway

Objectives:1. By analysis of the effects of clinical pathway, observe that whether medical practice is in accords with guidelines, and whether there is improvement in such parameters as medical quality, medical expense and medical efficiency.2. Provide basic research data for establishing and improving the system, work model, quality assessment and continuous improving system for clinical pathway.3. Provide basic research data for healthcare management department to assess and analyze implementation situation so as to make and improve relevant policy for clinical pathway.Methods:Through electronic information system infrastructures such as electronic medical records (EMR), medical picture archiving and communication system (PACS), medical prescription system, seventeen clinical pathways of30subspecialities including internal medicine, surgery, gynecology, oncology, ophthalmology, and otorhinolarynology were incorporated into the management system of clinical pathway. Selective cesarean section (obstetrician department), breast cancer (breast surgery department), adjuvant chemotherapy for breast cancer (medical oncology department), and community acquired pneumonia (respiratory department) were set as key research objects. Through soliciting information from medical affairs department, information department, medical records department, financial department and pharmacology department, obtain information regarding hospital stays, total cost of medical service, medicine cost, examination cost and so on before and after the implementation of clinical pathway, so as to investigate the implementation effects of clinical pathway. In combination with expert consultation, individual interview, literature review and so on, analyze the reasons for variance to further improve clinical pathway. Analyze data with SPSS13.0software, comparison between groups was made with t test, and numeration data was analyzed with chi square test.Results:After implementation of clinical pathways for four disease entities, hospital stays were all statistically reduced (P<0.05):hospital stays were reduced by1.8days for selective cesarean section, for breast cancer, they are reduced by3.5days, for adjuvant chemotherapy of breast cancer, they are reduced by1.1days, and for community acquired pneumonia, they are reduced by3.0days. Pre-surgery hospital stay for the two surgery condition-selective cesarean section and breast cancer were all significantly reduced (P<0.05):for selective cesarean section, they are reduced by0.6days, and for breast cancer,they are reduced by1.2days.The cured and improved rate was all100%in the experimental group and control group for selective cesarean section, with no statistical difference. For community acquired pneumonia, the cured and improved rate for experimental group was99%, for control group it was98%, with no statistical difference (P>0.05). The patient satisfaction were98%and95%in the experimental group and control group respectively for selective cesarean section,98%and93%respectively for breast cancer,97%and94%respectively for adjuvant chemotherapy of breast cancer,95%and91%respectively for community acquired pneumonia. It was significantly improved (P<0.05) for selective cesarean section, breast cancer and adjuvant chemotherapy of breast cancer, while the improve for community acquired pneumonia was not of significance statistically (P>0.05)After implementation of clinical pathway, total medical service cost, medicine cost and examination cost were all significantly reduced (P<0.05):for selective cesarean section, total medical service cost was reduced by1532.8yuan, medicine cost was reduced by1150.5yuan, and examination cost was reduced by182yuan. For breast cancer, they were2308.3yuan,1600.1yuan, and615.5yuan respectively. For adjuvant chemotherapy for breast cancer, they were1918.6yuan,1500.5yuan, and221.7yuan respectively. For community acquired pneumonia, they were2924.8yuan,2052.8yuan, and554.9yuan respectively.In terms of variance, it is generally well controlled. The reasons for variances were as follows:from department, medical professionals, patients, the cooperation between departments, and lack of refinement of documentation and so on.Conclusions:The implementation of clinical pathway reduced hospital stay, pre-surgery hospital stay and improved medical service efficiency. It to some extend partly solved the problem of "difficulty in getting medical treatment". The cured and improved rate was almost the same, and patient satisfaction was enhanced. To some extent, it improved medical quality. Total medical service cost, medicine cost and examination cost was significantly reduced. To some extend it contained inappropriate medical cost and partly solved the problem of "difficulty in getting medical treatment". Considering many factors negatively influencing the implementation of clinical pathway, relevant policy that fit the implementation of clinical pathway was suggested to make full use of clinical pathway.