Analysis Of Cholecystitis Inpatient Cost Before And After The Application Of Clinical Pathway Model In One Pilot Hospital

Objective: This study is designed with one experimental institution as the object and one pilot monopathy,cholecystitis as the focus.It collected the cost-related data of the disease,compare and analysis the change of medical cost and composition among the different application stage of clinical pathway model.Visit the managers and doctors for qualitative interview,to know the main measure and incentives in different time points of clinical pathway model.Find out the influential factors of cost under the local macro health policy.Explore the deep causes of the change and provide advice and reference for further development of clinical pathway model in China.Methods: The study combined theoretical research with empirical research.With information retrieval and data analysis,research the theory of clinical pathway model and medical service behavior.Collect the data(including basic condition,clinical situation and cost)of the patient of one disease in pilot institution.Data comes from year of 2007 to 2014,which is the time before,during and after the application of clinical pathway model in the hospital.Discount the data of annual cost base on the inflation rate,in order to analysis the average total cost per time,average daily total cost,average cost of medicine,average daily cost of medicine,the composition and change of the cost,from year of 2007 to 2014.Analysis the trend of the change by ITS(Interrupted Time Series),and use the theory and empirical data to find out the deep cause of the change in medical service behavior.Results: This study collected 2475 cases of cholecystitis from the year of 2007 to 2014.Including 1531 of female cases,accounting for 61.90% of the total cases,obviously higher than the number of male cases(P<0.05).The annual average of cases before the pilot project(year of 2007~2009)is 154.3,which is 106 during the project(year of 2010~2011)and 600 after the project(year of 2012~2014).The average age of the patients is 58.60 and it has the most cases in the range of 50 to 59.The case of old patients whose age above 60 after the pilot project has the proportion of 52.1%,which is obviously higher than before and during the project of 36.1% ~28.8%(P<0.05).During the whole 8 years,there are 84% of the patients take the social medical system,including urban workers essential medical insurance system,urban resident essential medical insurancesystem and new rural cooperative medical system.The proportion before and during the pilot project is about 65%,while the proportion is 91.1% after the project.The average length of stay is 10.04,which is 10.71,9.67 and 9.90 before,during and after the pilot project.It has an obvious difference between before and after the project(P<0.05).Medical cost results: According to the data after discounted(rate of 3%),the total cost before and after the pilot project has a rising trend by year,especially in 2014,the rising rate is 10.57%,and the rate during the project is negative.The average daily cost is rising by year before the pilot project,which is keeping rising in 2010 and decrease a little in 2011,it keep decreasing in 2012 and keep rising by year from the year of 2013.The rising rate is above 10% in the year of 2010,2011,2014,especially in 2013,which has a rate of 14.32%.The total cost of patients has no obvious difference between the different stages of the pilot project,but for average daily cost,the data during the project is 12.68% higher than before,this difference has statistically significant(P<0.05),but the data after the pilot project has no obvious difference between before or during the project.No matter for the totalor the average dailycost of medicine,the difference among different stage of pilot project has the statistically significant(P<0.001).The change of average total cost has a stable trend,while daily cost reduced significantly during the pilot project and rise after the project.The range of the rising after the project is as the same as that during the project.Average cost of drugs and the daily cost of the drugs reduced significantly during the pilot project and rise after the project.The range of the rising after the project is as the same as that during the project.The medicinecost during the project is lower than the other two stages of project.The average medicine cost proportion is 30.2%,the proportion of examination and assay are both 11%,labor cost has the least proportion of below 3%.The average medicine cost proportion after the pilot project is 31.34%,which is obviously higher than the proportion during the project(P<0.001).The average examination cost proportion after the pilot project is 12.97%,which is obviously higher than the proportion of 8% before and during the project(P<0.001),labor cost doesn’t have an obvious change.Conclusions: The medical service behavior of cholecystitis in the hospital is very standardized during the application of the pilot project;the medical cost doesn’t have an obvious difference among the three pilot stages.According to the three year after the pilot project ended,the achievement of the pilot project can just last in the early days.However,in the third year after the project ended,the total cost and medicine cost both raise obviously,the medical service behavior has also changed obviously.Therefore,further follow-up survey is needed to clear the further effect of the pilot project.In order to improve the income,hospital expanded the quantity of bed,the cause comes from the imperfect supporting measures of Medicare and the business risk brought by the application of pilot project.At the same time,the cancel of incentive mechanisms and management mechanism of the internal market in the hospital after the pilot project is the main reason for doctors to maintain a target income.We can say the further effect of pilot project is hard to achieve,if there’s no change in existing pricing system and compensation mechanism.