Study On Key Links And Control Strategy Of Clinical Pathway Management

As a new kind of quality management mode, clinical pathway has great effect in improving the quality of medical treatment, ensuring medical safety and reducing medical costs. Summarized the experience of clinical pathway in foreign country,we found that the clinical pathway management is a comprehensive system. It needs high levels of management techniques, advanced management concept, reasonable allocation of human resources and supporting incentive-restricted mechanisms in the hospital. At present, in the process of implementing clinical pathway,there are a series of problems such as the management concepts of hospital administrators fall behind, the infrastructure and information system of hospital is relatively backward, medical insurance mechanism is not sound, compensation mechanism of medical expenses is not supporting. The internal dynamics and external pressures are lack of clinical pathway management. The development of clinical pathway in China can not reach the expectations and the model of clinical pathway has not been widely used in China.This study intends to explore the key links through the process of clinical pathway management, to analyse the problems and formulate effective control strategies. To analysis the feasibility on the control of key links through the implementation effect in sample hospital.In order to provide theoretical and practical basis for the development of clinical pathway management in Chinese hospital.Sources and MethodsBased on the qualitative and quantitative methods to determine the key links of clinical pathway management by the Delphi method ;expert consultation; in-depth interview and questionnaire survey in sample hospital.To analyse the control plans and control programs using the analysis of typical case. To analyse the effect of the control of key links and find out the problems after control by the in-depth interview and the analysis of medical home.Results1 Analysis on the current situations and problems of clinical pathwayAt present,the research and application of clinical pathway management in foreign is in mature stage. The effect of implementation of clinical pathway in hospital is verified.The pilot of clinical pathway will be in full swing in China from 2009. The results of expert consultation and key insider interview show there are still a series of problems on clinical pathway.Such as the internal and external conditions of hospital is unclear;the preparatory work before implementation is insufficient; the responsibility during the process of implementing is not clear and the evaluation criteria is not exactly and perfect.2 Determine the key links of clinical pathwayOn the basis of individual in-depth interviews and literature review,to analyse the conditions of the hospital that implement clinical path management; the preparatory work before the implementation needs to be done ; the problem must be considered in the process of conducting and evaluation indicator in order to ensure the main links of the clinical pathways management. Selected the main part from the key links of clinical pathway by delphi method. In conclusion, the qualification that the hospital must be required; the preparing work before implementation; the issues must be considered in the execution and evaluation links were considered the first layer and there were 30 key links in the second layer.It is provided the basis for formulating the control strategy.3 The control strategy on key links of clinical pathwayOn the basis of the key links, the researchers assist the hospital administrators to refine the key links combined with the actual situation of hospital. Using the analysis of a typical case, combined with the basis of clinical pathway management in sample hospital, determine the control program on the key links of clinical pathway management.4 Analysis on application effect of the control strategy on key links of clinical pathwayCollection assessing the effects of relevant indicators of 258 cases of appendicitis and 259 cases of ventricular septal defect in A and B sample hospital. Meanwhile, carry out the surveys on patient satisfaction in the department that conduct the control strategy on key links of clinical pathway. The hospitalization days, total hospitalization expenses, drug cost, drug ratio, and patient satisfaction were compared before and after the implementation of process control by using T test and chi-square test. The results showed that after the implementation of process control; the average hospitalization days decreased 0.89 days;the average drug costs down 504.74 yuan and drug ratio fell 14.09% on the appendicitis patients; the average hospitalization days decreased 0.15 days; the average hospitalization expenses down 651.22 yuan on the patients of ventricular septal defect. Meanwhile, after the implementation of process control, the patients with the knowledge and understanding of the treatment process significantly enhance, the satisfaction of medical quality increased significantly.Analysis on the main factors of the total hospitalization expenses before and after the implementation of process control by multiple linear regression. The results showed that the main factors of the total hospitalization expenses were drug cost, drug ratio and the number of complications in patients with appendicitis; the main factors of ventricular septal defect were drug ratio, drug cost, medical insurance and the number of complications before implementation of process control.After the implementation of process control, the main factors of the total hospitalization expenses were all drug cost,.drug ratio, hospitalization days for the patients with ventricular septal defect and with appendicitis. Discussion and suggestionDiscussion1 Analysis on the key links of clinical pathwayBased on certain criteria, the researcher had been established the order of the key links judging by the importance. The design of path, diagnostic evidence, the choice of disease, the support of leadership in hospital, feedback and application of the results were the most important part of the process.2 Analysis on changes of relevant indexBased on the relevant principles, sample hospitals formulated time flow sheet for the patients, the efficiency of medical staff was improved, , the average hospitalization days of patients was decreased significantly. However, due to surgical changes, age, complications and other factors led to the the the total hospitalization expenses of patients with appendicitis increased slightly after implementation of process control; as irrational drug use still exist, supervision and evaluation programs had not improved led to the drug costs increased slightly and the drug ratio increased significantly in patients with ventricular septal defect.3 Analysis on patient satisfactionAfter the process control, the exchange and communication between doctors and patients were promoted, the trust and understanding was improved, the Doctor-Patient Contradiction was eased, the patient's awareness of the clinical pathway had significantly enhanced, at the same time the medical quality satisfaction increased significantly. 4 Factors of hospitalization expenses in the implementation of process The drug cost and drug ratio were always the main factors of the total hospitalization expenses before and after the implementation of process control,therefore, the rational use of drugs was an important measure to control the total total hospitalization expenses.Suggestion1 Using the model of PDCA cycle to promote the control of processThe PDCA cycle was applied to process control in the clinical pathway to maintain long-term carrying out in the hospital and make the control of process more scientific and reasonable.2 Promot continuous improve on the control of processPromot continuous improvement on the control of process and make relevant control strategies.(a) be strict path design to ensure the practicality of the clinical path text; (b)clear diagnosis to nail down patient access; (c)control the selection principle of diseases to ensure the results of the implementation; (d)improve the support of leadership to formate a virtuous cycle of clinical path management;(e)sum up experience and pay attention to results-oriented feedback and application.3 Increase government support to formate long-term mechanismForeign proven, the support of government policies was an important factor can promote the management of clinical pathway developing effectively. Government should unveil related systems to ensure the legal effect of clinical path management based on the existing experience; establish compensation for medical expenses and health insurance payment system that carried out to clinical pathways; increasing financial investment, establish of large-scale integrated hospital information system in the nationwide, promote to formate long-term mechanism on clinical pathway management.