Management Research Of Pathway For Transnasal Approach Of Pituitary Adenoma Resection During Surgery Periods

With the rapid development of China, the people's demand for healthy and rapid growth of medical costs are not only a problem facing the world, but also face of China's medical reform a major issue. How cost-effective use of limited medical resources to meet the medical needs of the people is the rapid growth of building a harmonious society, deepening medical reform a top priority. Learn from foreign medical management experience, established by Chinese version of the DRGs in order to implement DRGs on the premise that standard disease management, clinical pathwayway in the medical management of high quality and reflect the cost advantage of China's medical reform control attractive. The pathwayway of disease management is conducive to standardization and rationalization of health care resources use, in the end of 2009 China's Ministry of Health, the domestic part of the hospital for the selected clinical pathwayway pilot project. After checking the literature, at this stage on the pathwayway management articles are more domestic, but more emphasis on care and health education, the overall application of the disease less. As the complexity of the pituitary adenoma disease and the lack of clinical pathwayway application experience. In this study, as a starting point, through the transsphenoidal pituitary adenoma resection of perioperative management for the pathway, the pathway of management of hospital stay, hospital cost control performance, the impact on satisfaction, analysis of variance and the reasons provide optimization strategy for the management of pituitary adenoma pathways provide a theoretical basis.Purpose:(1) To study the feasibility of pathway management transsphenoidal pituitary adenoma resection perioperative(2) Pathway management study of preoperative hospital admitted, hospitalized day and hospitalization costs of control effect and impact on patient satisfaction to guide clinical work.(3) To evaluate the causes of variation and characteristics of transsphenoidal pituitary adenoma resection perioperative, to analyze the possibility of improvement, to provide management for the clinical experience and recommendations and provide ideas for future research.Methods:153 cases of transsphenoidal pituitary adenoma resection for the study were randomly divided into pathways and control groups, the pathway group of 77 cases managed in accordance with the requirements of the pathway, the control group of 76 patients were given routine treatment and care. The balance of the two groups were compared, the two preoperative hospital stay, hospital stay, total hospital costs, drugs, consumables costs, discharge satisfaction were compared, data processing and analysis using SPSS15.0 package. Cause and discuss the statistical variation optimization strategy.Results:(1) Comparison of two balance: general admission data (age, gender, ethnicity, marital status, occupation, education level, income level, disease duration, disease symptoms) to compare P>0.05, perioperative disease-related information (pituitary tumor type, tumor shape and size, complications, are consistent with the admission diagnosis, discharge a month due to the disease-related causes re-hospitalization) compared P>0.05, no difference between the two sets of equilibrium statistical significance, comparable.(2) Preoperative hospital stay and length of stay comparison: comparing two groups of preoperative hospital stay P<0.05, significant difference. Length of stay compared two groups of P<0.05, significant difference.(3) Hospitalization costs comparison: total hospital charges compared the two groups P<0.05, the difference was statistically significant. Compared two groups of drugs P>0.05, the difference was not statistically significant. Consumables costs compared two groups of P>0.05, the difference was not statistically significant.(4) Discharge Survey data analysis: two groups with or without medical insurance comparison P<0.05, significant difference. Whether to accept the two checks in hospital-based outpatient surgery compared P>0.05, the difference was not statistically significant; satisfaction compared two groups of P>0.05, the difference was not statistically significant. Hospitalization costs remain high for some patients, admitted days for some patients can not accept, the hospital environment can not meet the basic needs of patients. (5) Analysis of variation: patient reasons than other reasons, suggesting that the complexity of the disease, pituitary tumors; from medical causes and reasons set pathway analysis can be seen that there is room for improvement in this pathway.Conclusion:(1) In the clinical trial stage of the pathway of transsphenoidal pituitary adenoma resection perioperative management of patients to the pathway, in the process of setting standards for length of stay should leave some flexibility to meet the complexity of pituitary disease and combined disease and more features.(2) Pathway management in transsphenoidal pituitary adenoma resection perioperative applications feasible. Reduce preoperative admitted days, hospital stay was significantly reduced in particular, can reduce hospital costs, costs of medicines and supplies no significant effect.(3) Patients of the hospital survey results showed: complete examination of patients hospitalized for recognition is low, and can not believe that pathway management has an impact on hospital patient satisfaction.(4) Patient's own causes more variation and complexity of pituitary disease related; medical reasons and causes of variation prompted the pathway set pathway still room for improvement.(5) According to the type of pituitary tumor (without secretion), disease severity, with or without complications such as the establishment of a branch pathway is the future direction of development.