The Effect Evaluation On The Application Of Clinical Pathway Model In The Quality Management Of Monopathies

Objectives: To evaluate the efficiency of clinic pathway conducted in monopathy quality control based on the analyses of recorded data involving clinic pathway management in monopathy quality control in a hospital and to provide a useful manageable model for the total quality management in hospital.Methods: Between April 1,2004 and March 31,2007,the inpatients of 10 diseases with the same standard of diagnosis, therapy methods, enough sample size , and comparable features between groups were chosen as study subjects from a teaching hospital in Changsha City, and in a historical control study the patients with aplastic anemia (adult) , allergic purpura, acute cholecystitis, cholelithiasis, acute pancreatitis, acute pancreatitis (endocrine department), chronic sinusitis, chronic tonsillitis, hysteromyoma, interventricular septal defect and interventricular septal defect were managed as a trial group with clinic pathway between April 1, 2006 and March 31, 2007,and the patients with same diseases and comparable features were managed as a control group without clinic pathway between April 1, 2004 and March 31, 2005. All the data including information about patient's name , gender, nationality, age ,disease name , situation on admission ,classification of the case, time of operation, time of discharging ,hospital day, cost of hospitalization , drug expense and prognosis of disease were collected from the case records in a teaching hospital in Changsha City of Hunan. The comparing indexes were patient's name, gender, nationality, age, disease name, situation on admission, classification of the case. Cost of hospitalization, hospital days and drug expense were defined as the evaluating outcomes indexes. Numeration data were described as frequency and hypothesis test were performed with x~2 test or Fisher's exact probability; the measurement data were described as mean and standard deviation, and statistical inferences were conducted with t test or nonparametric test. TOPSIS method was introduced for the comprehensive evaluation of the application of clinic pathway in managing inpatients with such diseases. All statistical methods were performed with SPSS version 13.0 and the two-side significant test level was set up asα=0.05.Result: 854 patients of 10 diseases in trial group with clinic pathway were hospitalized between April 1, 2006 and March 31, 2007,and 1015 patients with same diseases in the control group were recruited between April 1, 2004 and March 31, 2005. The basic characteristics such as gender, nationality, age , situation on admission between groups were without statistically difference (P > 0.05 ) . Compared to control group, the results showed that the average hospital days and drug expense in the 10 monopathy decreased to different extend in trail group while the cost of hospitalization didn't decrease obviously. The average hospital days of allergic purpura of patients in trial group with clinic pathway were shorter than that of the patients in control group (8.3 vs. 10.9, P=0.015), the average hospital days of chronic sinusitis (7.4 vs. 8.3 , P=0.001) and chronic tonsillitis(5.9 vs. 7.8, P=0.030) of patients between group were statistically difference, respectively. The average cost of hospitalization of allergic purpura patients in trial group (3325.1 Yuan) was statistically difference from that of the patients in control group(5308.5 Yuan, P=0.010),and the drug expense of this disease between groups were different (1400.3 Yuan vs. 2622.9 Yuan, P=0.005),and the average drug expense of acute cholecystitis and cholelithiasis (2113.3 Yuan vs. 3589.3 Yuan, P=0.044), chronic tonsillitis (777.5 Yuan, 1232.6 Yuan, P=0.022), hysteromyoma(1530.5 Yuan vs. 2055.9 Yuan, P=0.002) between groups had statistical difference, respectively. The results of TOPSIS showed that the comprehensive efficacy of clinic pathway in the quality management for the 10 sample diseases was better than that of the trial group.Conclusions: From our study sample of the ten monopathies, we concluded that clinic pathway was a helpful model to shorten the average hospital days of patients with allergic purpura, chronic sinusitis and chronic tonsillitis, and to reduce the drug expense of patients with allergic purpura, acute cholecystitis& cholelithiasis, chronic tonsillitis and hysteromyoma as well as the average cost of hospitalization for patients with allergic purpura. The results implied that clinic pathway management model plays an important role in the quality management of the monopathy medical services.