Study On Effects Of Clinical Pathway Operations

The clinical pathway is defined by a patient care plan which is made by medical, nursing or related professional staff for developing a particular disease or surgery, with scientific (or rationality) and sequential. It aims to provide a patient-centered, cross-departmental and inter-service process integrating all the individual aspects of key processes. It works through the course of medical treatment for certain types of patients, in which the medical, nursing, medical technology, logistical support and other aspects of effective horizontal coordination may be involved. It is focus on improving hospital business in the medical and nursing aspects of the performance of core processes, in order to improve the hospital's overall operating efficiency.As a new quality management model, the clinical pathway with its enormous role in improving quality of care to protect the health safety and reduce medical expenses, received extensive attention from the administrative department of health and hospital managers. As one of the important tasks of public hospital reform, implementation of clinical path management is very significant for the promotion of health services management, including implementation of the national essential drug system, reducing the unreasonable medical expenses, building a harmonious patient Relations, and the protection of medical quality and medical safety. It is the third new development of hospital management, following the "patient-centered" hospital reforms. Based on the above background, by international research and related literature and interviews with health administration, the study states the overall implementations of clinical path managements in China, and summaries evaluation of the clinical path of key operating results and influencing factors according to the implementation of the current situation and existing problems. The evaluation indexes determined by Delphi expert consultation evaluation, are applied to the clinical pathway evaluations of sample hospitals to make atypical analysis of the run effects of clinical pathway in sample hospitals. At the same time, four pilot hospitals directly under the Ministry of Health are organized for a panel discussion on clinical pathway management experiences and issues, summarizing the clinical pathway management of advanced methods and making recommendations for common problems.Methods:In this study, qualitative and quantitative data are obtained by literature review, Delphi expert consultation, case study and analysis, and focus group discussions. The data were summarized and analyzed by statistical analysis methods such as descriptive analysis, chi-square test, and T test.Key findings:1) Status and problems in clinical pathway managements in China: Clinical pathway management researches and applications are basically in a mature stage abroad. From 2009, pilot clinical pathway managements are in full swing in China, and the effects are verified in relevant hospitals. However, the results show that there are still a number of issues:The scientific of the institution needs to be strengthened; performance evaluation mechanisms for hospitals and departments need to shift; the information systems become a bottleneck; a scientific and systematic evaluation system needs to be established.2) Evaluating indexes of the effect of running clinical pathways:After the framework of evaluation index system formed by reviewing of the literature review and two rounds of Delphi expert consultation, two level-one indicators--usiness assessment index and economic evaluation index are finally selected. Seventeen level-three indexes including "average hospital stay" are used to evaluate the run effects of clinical pathways from five aspects—"the quality of medical work'", "the efficiency of medical work","patient fees", "economic effect" and "rational use of resources".3) Typical analysis of operating results of clinical pathway:By the typical analysis of this study, there are little improvements in medical quality but obvious improvements in the efficiency of medical work in the sample hospitals after operating medical pathways, while the patient fees are reduced and the construction of fees become more rational in some extent. Besides, the results of the study show that running clinical pathway on hospital has little effect on the economic effects, but it can increase the level of rational use of hospital resources.4) Experiences in running medical pathway managements:As a new quality management model, running medical paths requires big attention form hospitals, and needs hospital rules and regulations, human capital investment, sectoral coordination, process optimization, and the control of key points. It is a necessary breakthrough for the management bottlenecks to strengthen the clinical pathway information systems.Policy recommendations:1) Establishing a scientific, systematic evaluation system of medical paths:Make reasonable choices of assessment and evaluation methods of the object to eliminate confounding and bias evaluation, and carry out the implementation of evaluation and timely intervention to improve the systematic evaluation.2) The design of information system of medical paths:The design needs to consider the diversity and operability of the design process. It not only works as a form of electronic paper path, and also plays a role in real-time monitoring, feedback and adjusting the operating of the process. Technically, it is not only necessary to upward connect the existing hospital information systems with the full range of efficient docking, but also backward compatible with the clinical pathway and the development of more specific data.