The Institution And Evaluation Of Acute Myocardial Infarction Clinical Pathways Of Integrated Traditional Chinese And Western Medicine

Backgroud:Acute myocardial infarction(AMI) is a cardiovascular disease which can seriosly endanger human health.AMI is called "the first killer" in developed country,and is the main mortality cause in the world.In our country,AMI is not as ususal as Europe and America,but its incidence had a growth trendency for the past few years.And AMI brings grave burden of medical cost to the society and family.In America,the expenses on coronary heart disease is over 60 billion dollors,and half of them is related with the prevention and cure of AMI.The medical cost of each AMI case is 12 thousand dollors.The average medical cost of AMI patients is about 28,257 Yuan in the subordinate hospitals of national ministry of heath in our counry in 2000,and which is the first in hospitalization expenses,In primary estimate,the direct medical cost of AMI is 5.02～19.67 billion Yuan.The increase of AMI incidence and medical cost have brought grave burden to individuals,families and society.To elevate the prevention and cure of AMI and to control its medical cost has become a important topic in the field of cardiovascular disease and health supervision.Clinical pathways(CP) is a standardization method of diagnose and treat, and its main characteristics is to shorten average hospitalization days and pay medical cost reasonably,to design the most reasonale medical and nurse scheme by entity,to arrange the hospitalization days and medical cost reasonably and to improve medical service quality.Every coutry has pay attention to the use of CP,and CP has become a new medical mode in new century.Our traditional medicine has built up a lot of experience in treat AMI. It has a great significance to educe each dominance of western medicine and Chinese medicine by constructing AMI clinical pathways of integrated traditional Chinese and western medicine,to explore the construction method of CP in hospital of traditional Chinese medicine,to improve the therapy level of integrated traditional Chinese and western medicine,methods of health supervision,quality and level of medical service.Purpose:It is to construct AMI clinical pathways of integrated traditional Chinese and western medicine,to evaluate CP,and to provide optimization integrated traditional Chinese and western medicine scheme of diagnose and treatment of AMI.Subject and methods:To construct AMI clinical pathways of integrated traditional Chinese and western medicine(including doctors version and patients version) by using experience of our country and other countries in CP research and operations for reference and following the principles and methods of CP formulation,and on the base of propaganda,training and consummating organization system,AMI clinical pathways of integrated traditional Chinese and western medicine was used in clinic.AMI patients were divided into traditional therapy(TT) group and CP group randomly.CP group was treated by CP flow-sheet of diagnose and treatment,as while TT group was treated by TT procedure of diagnose and treatment.At the end,the AMI patients' s information of hospital diagnose and treatment was collected by information system of Guangdong hospital of traditional Chinese medicine,in which hospitalization days,therapeutic efficacy,hospitalization expenses and so on were added up and application effect of CP was evaluated.The main subject and methods included:1 Construction of the organizational management system of CP.2 To institute and consummate AMI clinical pathways of integrated traditional Chinese and western medicine on the base of previous study and by way of literature retrieval,case review,expert consultation and so on.3 The organization and implementation of AMI clinical pathways of integrated traditional Chinese and western medicine.4 To design a randomized controlled trial,to observe the effects of CP on length of stay,medical cost,main adverse cardiovascular events and so on, and to explore the efficacy of AMI clinical pathways of integrated traditional Chinese and western medicine. Results:1 Construction of AMI clinical pathways of integrated traditional Chinese and western medicine.1.1 Installment of the organizational management system of CPThe guidance group including methodology group,quality controlled group, management group,implementation group and soon was established in Guangdong hospital of traditional Chinese medicine,and the responsibility of related staff was identified.1.2 The formulation of CP flow chartThe formulation of CP flow chart was recapitulated on the base of key events which happened or not and time sequence in CP.General flow chart of CP,nursing flow chart of CP and patients flow chart of CP were designed.1.3 The determination of standard hospital dayMedian method was adopted in the study.On the base of cases review,the median of hospital day was regarded as standard hospital day,and which was combined with clinical factor.In the study,standard hospital day was 9.1.4 The formulation of menu of AMI clinical pathways of integrated traditional Chinese and western medicineThe menu of AMI clinical pathways of integrated traditional Chinese and western medicine was formulated by way of cases review,Evidence-based medicine,principle of Vilfredo Pareto and so on,and which was continuously modified and feedback in clinical practice.2 The evaluation study of AMI clinical pathways of integrated traditional Chinese and western medicine2.1 The effect of CP on length of stay:there was statistical difference in ICU length of stay and total length of stay between CP group and TT group (P＜0.05).It mean that CP could reduce length of day.2.2 The effect of CP on hospitalization expenses:The total hospitalization expenses,interventional expenses,and other expenses in CP group were all lower than that of in TT group.There was statistical difference between two groups in other expenses(P＜0.05),but no statistical difference in other two expenses(P＞0.05).2.3 Main adverse cardiovascular events:there was no statistical difference between two groups(P＞0.05).2.4 Angina pectoris occurrence in duration of hospital stay and follow-up period:Whether in duration of hospital stay or follow-up period,there was statistical difference in angina pectoris occurrence between two groups (P＜0.05).2.5 Heart function information in duration of hospital stay and follow-up period:Whether in duration of hospital stay or follow-up period,there was statistical difference in heart function information between two groups (P＜0.05).2.6 The evaluation of clinical therapeutic effect of traditional Chinese medicine:In CP group,among the 30 cases,16 cases were markedly effective, 12 cases were effective and 2 cases were ineffective,the total effective rate was 93.33%.As for TT group,among the 30 cases,8 cases were markedly effective,17 cases were effective and 5 cases were ineffective,the total effective rate was 83.3%.The CP group was superior to TT group in the effectiveness of clinical efficacy(P＜0.05),but there was no statistical difference in total effective rate between two groups(P＞0.05).2.7 The evaluation of patients' satisfaction:there was significant statistical difference between two groups(P＜0.01).Conclusion:The length of stay,menu contents and other contents were designed by using the method of historical review,by means of information system of hospital, by following the principles of evidence-based medicine and Vilfredo Pareto. The flowsheet which was designed was applied into clinical practice,and implementation effect was evaluated.The study conclusion shows us:1 The application of AMI clinical pathways of integrated traditional Chinese and western medicine can reduce length of stay and hospitalization expenses of AMI patients.2 The application of AMI clinical pathways of integrated traditional Chinese and western medicine can reduce the occurrence of angina pectoris and improve heart function of AMI patients both on duration of hospital stay or follow-up period.3 The use of Traditional Chinese medicine in AMI clinical pathways of integrated traditional Chinese and western medicine can improve clinical effect of AMI patients.4 The application of AMI clinical pathways of integrated traditional Chinese and western medicine can improve the satisfaction of AMI patients.