The Study On Clinical Pathway Of Inpatient Benign Prostatic Hyperplasia In One Selected Hospital

ObjectivesThrough analyzing the entire surgical treatment of benign prostatic hyperplasia in the department of urology in one selected hospital, the paper tries to find the reasons for the rising medical care cost of studied disease, and formulates the clinical pathway for inpatient surgical treatment of benigh prostatic hyperplasia which may prompt the standardized behavior of the clinical services, streamline the processes and save medical resources.MethodsBased on retrospective survey of 73 patients with surgical treatment of benign prostatic hyperplasia in a hospital in 2008, the paper tries to find the influencing factors of the medical care cost and the standard hospitalized days by statistical methods. Supplemented with key informants interview and expert consultation methods, we formulate the clinical pathway (CP) of benign prostatic hyperplasia.40 cases who were treated by CP from July 2009 to June 2010 and 127 cases who were not treated by CP from July 2007 to June 2009 were studied by comparison analysis and the variations were also analyzed. Different statistic methods including general descriptive statistics, non-parametric test, correlation analysis, multiple linear regression, evidence-based medicine, key informants interview and expert consultation were used in CP process and medical record form formulation. The general descriptive statistics, T-test, non-parametric test and chi-square testing methods were used to assess the effect of implementing CP.Results(1) Based on the cases which were not treated by clinical pathway, the cost structure of the fee of medicine, surgery materials and laboratory was 42.68%,30.44% and 12.68%, respectively,85% of share of the total fee.(2) The single factor analysis for the hospitalization expenses showed that the ward, patients age group, preoperative complication, operation methods, the days after bladder washing, the variety of antibiotic use, the average unit price of antibiotics, the number of antibiotic use, blood transfusion and postoperative complication of the experimental group were all different from which of the control group. The differences were statistically significant (P<0.05).(3) The result showed that a high positive correlation between the charges per case and the average hospital stay, and the correlation coefficient was 0.65 (P<0.01). Meanwhile, it also showed that a high negative correlation between the daily cost and the average hospital stay, and the correlation coefficient was-0.76 (P<0.01).(4) Multiple factors in hospital cost analysis showed that:the influencing factors included the number of antibiotic use, hospital stay, the average unit price of antibiotics, the days after bladder washing and ward (R=0.88).(5) Processes and forms of development of clinical path was based on the analysis of treatment processes, feasibility analysis and control analysis. Then it was confirmed finaly by completing the content of the process and form and laying down the entry and exit roles. In the study of design, it showed that the determination of the standard length of hospital stay can make hospitalization costs and unreasonable cost increase under control. Besides with the time as the horizontal axis of the form design, the implementation of clinical pathways can be more simple and easy to operate.(6) The comparative study in the surgical treatment of benign prostatic hyperplasia clinical pathway group and the control group showed that: in the measurement data, the hospital stay of the two groups was 7.00 days and 8.91 days, daily cost was 1286.04 RMB and 1189.78 RMB, charges per case was 8634.31 RMB and 9680.37 RMB, the days after bladder washing was 2.63 days and 3.59 days, the variety of antibiotic use was 2.50 and 2.94, the number of antibiotic use was 40.23 and 50.87, the average unit price of antibiotics was 29.04 RMB and 37.55 RMB, medicine fee was 3429.60 RMB and 4204.89 RMB, surgery materials fee was 2934.21 RMB and 3131.37 RMB and laboratory fee was 1150.26 RMB and 1257.54 RMB. So the hospital stay, hospital cost, the days after bladder washing, the varieties of antibiotic, the average unit price of antibiotics, medicine fee,'surgery materials fee and laboratory fee of the experimental group were all lower than which of control group. The result was with statistical significance (P<0.05). But the result of the daily cost and he number of antibiotic use was with no statistical significance.In the enumeration data, postoperative complications and disease development of the experimental group were better than the control group. The result was with statistical significance (P<0.05). But the result of blood transfusion was with no statistical significance.(7) In the comparison of patient satisfaction, the average of satisfaction with the doctor, the nurse, the relevant departments, the logistics services and the whole of the hospital was 94.22%,84.27%,90.36%,84.45% and 92.00% in the group of implementation, respectively, and 76.00%,71.05%,74.46%,82.52% and 76.47% in the control group, respectively. So the satisfaction with the doctor, the nurse, the relevant departments and the whole of the implementation group was significantly higher than the control group, but satisfaction with the logistics services was not.(8) The variation among the experimental patients was analyzed from the hospital system, medical staff, medical condition of patients, disease development and exit path. In all, we found 71 cases have positive variation while 50 cases with negative ones. For all of the variations, positive variation was mainly existed in medical staff, while the hospital system has the numerous negative ones.Conclusion In the study, clinical pathway of inpatient benign prostatic hyperplasia showed that the implementation of clinical pathways standardize the behavior of department clinics, reduced the average hospital stay and cost effectively, improved patient satisfaction with hospital and brought good economic and social benefits to the hospital.