The Investigation And Analysis Of The Clinical Pathway For Chronic Heart Failure By Delphi Approach

PurposeThis study aimed to investigate and analyze key problems of the new clinical pathway to chronic heart failure determined by Heart Center in Guangdong Provincial TCM Hospital,using Deuel the Philippine(Delphi) approach,and to evaluate,optimize and improve the clinical pathway. Hopefully,that will finally help formulate a profession approved diagnosing and treating plan for chronic heart failure by best combing Chinese and Western medicine,and enable the clinical pathway to implement in clinics.MedthodsThis research was based on previous studies(including reviewing existing ways of treating chronic heart failure,categorizing relevant literature of ancient TCM,and organizing relevant literature of modern TCM and so on). Predicting team has formed and questionnaire has been designed in accordance with the newly determined clinical pathway to treat chronic heart failure. Deuel the Philippine(Delphi) approach was used in the questionnaire to get answers from professionals of cardiovascular internal medicine all over the country.The questionnaire,covering clinical pathway of diagnoses, treatments and evaluations,asked the experts evaluate the present clinical means according to the actual situation of present chronic heart failure diagnoses.After each round of questionnaire collection,the prediction team would carry out statistical analysis,opinions categorization,modification of previous questionnaire,and formation of new questionnaire for experts of next round.In the statistical analysis aspect,it was done by Epidata2.1a and spss13.0 procedure in computer.This team has done descriptive analysis to expert's positive feedbacks and the basic situation.Frequency description has been applied analyze each element of the questionnaire.ResultThere were two rounds of questionnaire collection altogether:in the first round,the questionnaire return ratio was 100%,and experts' positive feedback was 100%.In the first round,20 experts,engaged in the field of integration of Chinese and Western heart internal medicine,were from 9 provinces and cities.All the 20 experts were professors,who were engaged in this specialty for 10 years or more than 10 years,which indicates that they were good representatives and authority in this field.In the second round, the questionnaire return-ratio was 100%,the experts' positive feedback was 100%.All the 15 experts were professors who have been engaged in integration of Chinese and Western heart internal medicine for 10 years or more than 10 years,which indicates that they were good representatives and authority in this field.In the first round 85%of the experts believed that controlling medical expense through the management of clinical pathway was reasonable; 95%experts thought it was reasonable to use management of clinical pathway to standardize medical behaviors and to improve medical quality.95%experts approved that,in the clinics,doctors,practicing western medicine,should diagnose by referring to the 2007 "China Chronic Heart failure Diagnosis and Treatment Guide".As for TCM approach,80%experts chose symptom differentiation plus syndrome differentiation and treatment.90%experts recommended to separate the acute aggravation time and the stabile period into two stages to carry out syndrome differentiation and treatment.In the second round,80%experts agreed that 14 days was the exact period of time for clinical management.73.3%experts' agreed the separation of acute aggravation time and stabile period.80%experts verified the main syndrome,secondary syndrome, and tongue image.Data of these experts' descriptions for each syndrome have been studied,and initial common points between them have been found out.ConclusionThis is a study on the evaluation and optimization of clinical pathway for chronic heart failure by using Deuel the Philippine(Delphi) approach. It helps to make the clinical pathway better and more reasonable.Based on the opinions offered by the experts,we initially formulate the profession standard for treatment of chronic heart failure by integrating Chinese and Western medicine.Simultaneously,it has proved that Deuel the Philippine (Delphi) approach is scientific and practical,which involves experts wisdom, knowledge and experiences,and is a scientific methodology to assure TCM research to be objective,practice,traditional and applicable.