Research Of Development And Implementation Of Clinical Pathways And The Resection Of Primary Liver Cancer Of Single Disease-related Factors

The analysis of single disease-related hospitalization costs and their development and implementation of clinical pathways are not only important methods to control and reduce hospitalization costs and shorten hospital stays, but also one of the main focuses on the reform of medical and health undertakings in China. However, study analyses of domestic hospitalization costs have focused only on relatively simple diseases, and there have been rare effective implementations of clinical diagnosis and treatment of more complex diseases.This study is intended to have the resection of primary liver cancer as the research object. Such clinical materials as hospitalization costs, the length of hospital stays and other relevant clinical data were first sorted out and analyzed on patients with resections of their primary liver cancers in a large army hospital for the last three years. The characteristics of the distribution were described statistically, and the relationships between various clinical characteristics of the patients and their hospitalization costs and length of hospital stays were analyzed by applying single–factor variable analysis and multvariate linear regression model, and attempts were made to identify such factors that play decisive roles in hospitalization costs and length of hospital stays. The median total hospital costs per patient were 23830.53 yuan. Medication costs composed the largest single category of costs, accounting for median costs of 10434.87 yuan or 40.2% of total hospital costs. The second category of costs was fundamental treatment costs which accounted for 5600.73 yuan or 21.6% of total hospital costs. Other categories were, in order of magnitude: operation procedure (11.8%;3067.47 yuan); laboratory test (6.6 %;1711.2 yuan); radiological test (5.8%;1499.37 yuan); blood transfusion (4.9%;1279.95 yuan); anesthesia (4.5%;1169.5 yuan); bed (2.7%;692.07 yuan); nursing (1.2%;199.41 yuan) and consultation (0.7%;145.59 yuan). Six variables were statistically significantly different by using univariate analysis to determine factors related to increased hospital costs. Total costs per case were increased in urban patients than those from rural patients (27054.9 vs. 21886.8 yuan,P=0.029). The higher total costs was also associated with increased Child-Pugh score (24322.5 vs. 34851.9 yuan, P=0.014) and wide extent of surgical resection (21369.3 vs. 25067.7 vs. 28572.9 yuan, P=0.045). Besides, the patients who underwent blood transfusion (27820.8 vs. 23860.2 yuan, P=0.026) and those with surgical complications (32554.2 vs. 24488.1 yuan, P=0.018) tended to have higher hospital costs. Furthermore, the total costs were also significantly increased in patients with increased LOHS (19858.2 vs. 27448.2 vs. 38909.1 yuan, P=0.000). Factors associated with increased median LOHS included Child-Pugh score, surgical procedure and surgical complication. Patients with higher Child-Pugh score(18 days vs. 13 days, P=0.023), broader extend of resection(15 days vs. 13 days and 11 days, P=0.010) and surgical complications (18 days vs. 13 days, P=0.002) tended to have significantly longer total LOHS, indicating that the factors resulted in relatively more LOHS were significantly associated with operation. The multiple linear regression analysis indicated that the average length of stay in hospital was key factors to determine the costs of hospitalization which were also affected independently by such relatively minor factors as surgery blood transfusion, postoperative complications, and preoperative liver Child-Pugh scores. In addition, factors which might be used to predict the length of hospital stays included postoperative complications and options to carry out surgeries. The research results have suggested that primary liver cancer resections have their own respective characteristics and different determining factors on hospitalization costs and length of hospital stays in Chinese hospitals. These would provide important reference data for the development and implementation of clinical pathways of such single disease as liver cancer resections.Based on this, texts of clinical pathways for treatment and nursing care were initially developed for resection of liver cancer by referring to literature existed and consulting the doctors and nurses from clinical departments. The preoperative, operative and postoperative treatments and care processes were quantified and standardized. Then the pathway was used in clinical practice, and the prospective randomized control study was carried out by including 68 cases with liver cancer resection, who were randomly divided into the clinical pathway group and the non-clinical pathway group, to observe and analyse the effect of implementation of clinical pathways on hospitalization costs, length of hospital stay, the treatment the patients enjoy satisfactorily and other factors, and factors related to variability were analyzed. The results have shown that the implementation of clinical pathway can significantly reduce hospitalization costs (21398.67 VS.26379.36 yuan) and shorten the average length of hospital stays (4.4 VS. 2.4 days), and at the same time can obviously improve the satisfaction of patient treatment. These results have initially confirmed the feasibility and effectiveness of clinical pathways introduced in primary liver cancer resection of more complicated cases, and thus to provide important clinical references for future studies of multiple centers and large size of samples.