| BackgroundWith improving of living standard, aging of population, changing of life style and progressing of diagnosis, quantities of people who suffer form diabetes increase rapidly, and the age of patients are much younger. Diabetes has become the third Noncommunicable Diseases in developed countries follow Cardiovascular Disease and Cancer. It is a cosmopolitan problem which threatens public health severely. According to the result of investigation in Chinese 11 province, 1997, there were about 30 million people suffered form diabetes, and it displays a new increase of 1 million. Diabetes lead to an incredible medical cost, we spent 2.216 billion yuan on diabetes treatment in 1993, with the increase of medical cost recently, the economic burden thanks to diabetes still will aggravate. Apply Clinical Pathway to the therapy of diabetes, can improve medical quality, reduce medical cost, accelerate improvement of hospital performance, to make limited medical resource into best collocated. It means a great deal to resolve the problem of "hard to see a doctor and expensive to see a doctor".Clinical Pathway medical manage system hasn't formed, this study just begin at present in China, but explore how to make use of Clinical Pathway has become an inevitable and important choice, it is a trend to apply. Several hospitals in China applied Clinical Pathway to diabetes health education showed that Inpatient Clinical Pathway can obviously shorten average day be in hospital, reduce cost and improve medical quality, patient satisfaction and self-supervise ability. For outpatient, it is a blank in China. On the other hand, abroad in Singapore for example, non-insulin dependent diabetes manage system is carrying out now, it make whole process of diagnosis and treat can better work and it is welcomed by doctors and nurses. Looking forward to seeing us can catch up with other countries in Clinical Pathway and exceed developed countries.ObjectiveBase on concept of Clinical Pathway which use in object manage and process manage and the international authoritative diabetes guideline, according to the retrospective research and bottleneck evaluation on therapy plan, treat time and curative effect of diabetes patients in the second affiliated hospital of Zhejiang University, to find out the key tache in the process of diagnosis and treat. Further, build a scientific and dynamic type 2 diabetes Clinical Pathway manage model to guide a electric call system of diabetes patients formed. And then, try to discuss reasons of bringing medical quality differences and how to deal with it in a systemic perspective. Offer references and advice to medical system reformation, to seek a "high quality and efficiency, but low waste" health care model which adapts to economic development of our country, make full use of medical resource and reduce medical cost. MethodsThis article combines qualitative research with quantitative research, base on concept of Clinical Pathway which use in object manage and process manage and the international authoritative diabetes guideline to build a manage model, furthermore, evaluate the feasibility.1. Choose object: (1) Inpatient system: The result of pilot study show that standard pathway can cut the cost by 1774.26 yuan, on the other hand, the standard deviation of cost is 1128.38 yuan, if we think over two-sided test, α =0.05 and β =0.2, we can calculate and get that it makes sense if we choose more than 39 patients into each group in our survey. We adopt historical cohort study and use systemic sampling to choose 200 patients from type 2 diabetes who had ever been in the second affiliated hospital of Zhejiang University last 3 years, and then divide into two group to evaluate and contrast their medical effect. (2) Outpatient system: According to the result of investigation in Chinese 11 province, 1997, the standardized prevalence rate is 1.99%≈2.00%, when permitted error is 2%, we can calculate and get that it makes sense if we choose more than 188 patients into our survey. We adopt prospective cohort study to follow up these 200 patients and evaluate the medical effect between former and after the electric call system of diabetes patients formed. (3) Evaluation system: Choose 30 expert who concentrate on medical, nurse and management.2. Methods: Adopt literature information analysis to look back the therapy plan, treat time and curative effect which is practiced in the Hospital and give a hypothesis to study out the elementary standard pathway. Base on several times experts discussion, feed back many suggestion to edit the elementary standard pathway. Finally, we can build a scientific and dynamic type 2 diabetes Clinical Pathway manage model to guide a electric call system of diabetes patients formed. Furthermore, we adopt questionnaire and interview to get many significative information to evaluate medical effect and analyse differences, then we can get solution to deal with the problem existed.3. Statistic analysis: We adopt 'Epidata 3.0' to build a database, on the other hand, data processing is under the 'SPSS 13.0 for windows' and 'Excel'. We evaluate the qualitative date by x~2 test, but descriptive quantitative data are given as x|-±SD comparison between two groups are evaluated by ANOVA tests for continuous variables, whereas discontinuous variables are evaluated by Nonparamatric Test. Moreover, after 3 times Delphi Methods, we get the results and given a parallel test, from parallel test result we can find whether doctors and nurses are consistent with influence factors. Then adopt Topsis Methods we can get the order of the most important factors. A P value of less than 0.05 was considered significant. Main Results1. Type 2 diabetes Clinical Pathway manage system2. Evaluate the medical effect of manage system Inpatient system: The patients of standard group are much older, longer course, with poorer kidney function, more and worse complication than nonstandard patients. On the other hand, they adopt poorer screening and evaluation measure. At the same time, anti-hyperglycemic drug and insulin are widely used. The days in the hospital are longer but with lower cost. Outpatient system: The manage model are used to guide a electric call system of diabetes formed, we can forwardly precontract and manage patients, ensure patients are able to see a doctor on time to monitor plasma glucose and other key value of health, and then we can adjust the therapy in time. At the same time, we improve the medical quality and satisfaction, control the development of diabetes effectively, prevent or control complication.3. Other factors: The order of the most important influence factors is: time of waiting for the examination, items of examination, type of insulin, type of anti-hyperglycemic drug, ability of self- supervise, quality of nurse, professional level of doctors, system of education, compliance of patients, meal control and do exercises.ConclusionAccording to retrospective research and difference analysis, we find there are many differences in the process of diagnosis and treat. We need adopt Clinical Pathway to standardize medical behaviour and improve medical quality, as well as strengthen management of key tache in the process of diagnosis and treat. Reduce unnecessary and unreasonable medical behaviour, to seek a "high quality and efficiency, but low waste" health care model and make full use of medical resource and reduce medical cost. Solution and Suggestion1. Shorten the time of waiting for examination2. Perform examination reasonably3. Improve the professional levels of doctors and nurse, prescribe reasonably.4. Standardize medical behaviour, improve service attitude.5. Contact with community, perform 'Levels of care'.
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