Study On Performance Evaluation Of The Medical Service Management Based On Clinical Pathway

As a standardized treatment plan, the clinical pathway has played an important role in the ensuring of medical quality and controlling of medical expenditure with the aim of creating a safe, effective, convenient and low-price basic medical care. With the rapid economic and social development of and the deepening of medical and health system reform, the clinical pathway has been gradually promoted by the Chinese health administrative department. As a factor, the performance appraisal has played an active role in the clinical pathway management, andcan make the hospital management to be clinical-pathway-oriented. However, there were few studies on the performance appraisal of clinical pathway and most of the existing studies were performed only from the effect without considering of the fact that our clinical pathway was on its primary stage whose function relied on the reasonable location of basic management elements. Meanwhile, some evaluation was too macroscopic and far from enough. Considering of the actual need, based on the medical care management , the performance appraisal study of clinical pathway was studied with the aim of improving the level of clinical pathway and realizing its function, which, to some extent, is boh theoretically and practically significant.ObjectivesBased on the function achieving of clinical pathway, we wanted to ensure the performance indexes, measure points and index weight for the construction of performance evaluation index system. After it, through the empirical research,we hope to identify the subject, object, form, basis, method, analysis idea for evaluation, and to set up the performance evaluation system for medical care management based on clinical pathway.Method1. Literature analysis. Retrieval and read documentary about medical performance evaluation and clinical pathway at home and abroad.2. Expert consultancy method. Through well designed questionnaire for the experts, performance evaluation indexes will be identified. 30 experts participated in the three rounds consultation in total , including four health administrators, six academic researchers from research institutions, six hospital administrators, and 14 medical staff.On the basis of expert consultation, we also invited 34 experts with professional background and working experience to come up with their amendment opinions in terms of feasibility and sensitivity of indexes . there were 32 expert actually took part in the consultation, including eight health administrators, 10 academic researchers from research institutions and 14 medical staff. In total, through three rounds of expert advice to integrate the amendments, further improving the evaluation index.3. Focus group discussion. On the basis of the construction of the index ,we ensured the measure points for performance evaluation using focus group discussion. personnel who participated in the discussion included five health management experts, three deputy dean, four qc coco, eight department directors with the implementation of clinical pathway and four administrative director, a total of 24.4. Expert scoring method. We selected 30 experts, including four administrators, six health management researchers, 7, 8 directors from hospital medical sections, five clinicians, and adopted expert judgment, personal use 100 points for each one of the primary indicators of the relative importance of secondary evaluation index scores determines the index weight, respectively.5. Typical case analysis. Gained the subject, object, form, basis, method for evaluation and made test on the medical care management in an general hospital for performance evaluation.6. Statistical analysis method. By SPSS12.0, we took describable analysis.then, used Excel 2003 to set up database, made standardization and compute of indexes and painting for performance limit graph.Result1. Influence factors analysis of medical care management for performance evaluation based on clinical pathway.The clinical pathway meets the need for the quality ensuring and cost controlling, and the clinical pathway elements, such as organization construction, text designing, medical personnel idea, department performance, whole nursing level, should all be taken into the performance evaluation system.2. The setup of performance evaluation index system based on clinical medical service management.The performance evaluation index system is divided into three levels based on the clinical pathway of medical service management. The first layer is seven indicators, organization and leadership role, strategic planning, with patients and the market as the center, measurement, analysis and knowledge management, human resources development, management and operation results, and the weight coefficient is 0.1175, 0.0838, 0.0838, 0.0875, 0.0887, 0.0887, 0.4500 respectively. The second layer is 30 secondary indexes.3. Empirical research of performance evaluation for the clinical pathway of medical service management.We took evaluation on the general hospitals about medical management with total scores by 1,000, and the total performance level is 623.82 points. Among them, leadership role standards, actual score is divided into 70.5 points, defects is 40%, strategic planning standards, scoring is divided into actual 58.7 points, defects is 30%, in patients with the market as the center, practical standard into a score of 57 points for 32%, and tools, measurement, analysis and knowledge management with the standard points 87.5, actually score is 54.3 for 38%, human resource development, practical standard into a score of 56.8 for 36%, defects, process management with the standard points 88.7, actually score is 65.6 for 26%, operation results with the standard into a score 450, actually score is 261 for 42%.Conclusions1. Clinical pathway management meets the need of health care development. With the increasingly complement from medical care market, nonstandard action in health service, idea of maintaining legal rights and increasing medical expenditure, we should promote hospitals to ensure the medical quality management and safety control, medical treatment cost, to strengthen the competitive power.2. The performance evaluation index of clinical pathway management has stronger pertinence. The index system gained in the study is closely combining the working practice, clinical pathway management, and it not only concerns the results of clinical pathway management, but also pays an attention to the process as well as the input. With the performance index for evaluating factors, it can guide hospitals to make a better location in clinical pathway work.3. The performance evaluation index has a reasonable weight. This study used expert evaluation method to setup secondary indexes enactment right. Although weighting method was a little subjective, it totally met the true neet of clinical pathwa y management.4. The empirical study showed the process of performance evaluation for medical service management based on clinical pathway. The empirical study indicated evaluation subject, evaluation objects, evaluation basis, evaluation result and evaluation analysis, which offered an example for the performance evaluation of medical service management based on the clinical pathway.