The Study Of The Electronic Clinical Pathway To The Patent Ductus Arteriosus Occlusion

The clinical pathway is a clinical diagnosis and treatment mode in orderto helping America hospital control the rising health care costs. At present,the clinical pathway has been widely used in abroad， and achievedremarkable results in improving health care quality，reducing hospitalizationcosts and reducing hospital days. However, in the domestic, the clinicalpathway application is still at the exploratory stage. In2009, The Ministry ofHealth required the clinical pathway must be piloted across the country,Patent ductus arteriosus as one of the diseases to be incorporated into theclinical pathway management model, its medical costs is expensive. how toreducing the health care costs, improving patient satisfaction is the urgentproblem need to solved. The clinical pathway is implement enforced, butpractical electronic clinical pathway has not been developed. At present, inthe context of most hospital are already using electronic medical records,because of the inherent flaws of the paper-based clinical pathway, it mayberestrict the promotion and development of the clinical pathway to some extent. Therefore, need to developing the electronic clinical pathwaycombine with the electronic medical records immediately, in order toincreasing the feasibility of the clinical pathway, the compliance of themedical staff and improving the efficiency of the medical staff.To solve the above problems, this study will start from the followingtwo parts:1.Draw up the patent ductus arteriosus occlusion clinical pathway andits clinical application.2.Patent ductus arteriosus electronic clinical pathway programmingand its try.PartⅠ：The patent ductus arteriosus occlusion clinical pathwayformulate and its clinical applyObjective：To formulate patent ductus arteriosus occlusion clinicalpathway for providing basis to the clinical application；To apply patentductus arteriosus occlusion clinical pathway in clinic, verify the rationalityof the clinical pathway and its effect in the patent ductus arteriosusocclusion.Methods: Use the content analysis, the pareto principle and the focusgroups formulate patent ductus arteriosus occlusion clinical pathway,applied the formulated clinical pathway in patent ductus arteriosusocclusion patients in department of cardiology, of which47cases weredischarged in January2010to October2010for the control group,44cases were discharged in November2010to October2011as the experimentalgroup. Use SPSS17.0software collected and analyzed the data；generaldescriptive statistic, stepwise multiple regression analysis, t-test andchi-square test as the statistical tests.Results:1.The patent ductus arteriosus occlusion clinical pathway entrycriteria, exit criteria and discharge criteria, the physician edition and thenurse edition patent ductus arteriosus occlusion clinical pathway table andvariance table have formulated.2.Compared the application effect of the clinical pathway and thecontrol group, at the aspect of the hospitalization cost: the clinical pathwaygroup patients’s inspection fees and other fees of classification of costs arelower than control group（P<0.05），the rest of the classification of costswith no significant difference between two groups（P>0.05）; the total costof the clinical pathway group is lower than the control group（P<0.05）, butcompared the average daily cost is no statistical significance（P>0.05）.preoperative length of stay and hospital stay of two groups difference haveno statistically significan（tP<0.05）. At complications: after the first day ofresidual shunt in the experimental is higher than the control group（P<0.05）,postoperative murmur and abnormal postoperative the examinationexperimental group are lower than the control group（P<0.05）.The patientsatisfaction of the clinical pathway group is significantly higher than the control group（P<0.05）, the total medical staff’ satisfaction to the clinicalpathway is87.11%. In the clinical pathway group has been5casespositive variation and9cases negative variation occurred，The causes ofvariation are system reason and patients with complications.Conclusions:1.Diagnosis criteria of the clinical pathway is the key link to formulateclinical pathway，determine the hospitalization days is the important link; itis necessary to formulating physician version and nurse version clinicalpathway respectively.2.The medical staff satisfaction of patent ductus arteriosus clinicalpathway had a higher degree；the patent ductus arteriosus occlusion clinicalpathway can make following effects: reduce medical costs, improve thequality of medical care, increase patients satisfaction.3.optimize the medical care system and manage the comorbidities andthe complications rationally are the key to implemented the patent ductusarteriosus clinical pathway with a high quality.Part Ⅱ：The patent ductus arteriosus occlusion electronic clinicalpathway programming and its tryObjective: To develop electronic clinical pathway and try it, toexamine its rationality and practicality, to lay the foundation for exploringthe effective model to developing the electronic clinical pathway and the application and the development of the electronic clinical pathway.Methods: Use literature analysis，sample interview and focus groupobtain the function of electronic clinical pathway；the client side usePowerBuilder9.0as the development tool，the service side use Oracle10Gas the database developed electronic clinical pathway；the programmedelectronic clinical pathway was try in medical personnel，for improved andevaluated electronic clinical pathway.Results:1. Electronic clinical pathway function including: the clinical pathwaytemplate formulate and maintain, doctor’s orders management, clinicalpathway and variation management, statistical analysis and project alarmfunction.2.Developed a set of electronic clinical pathway meet the hospital’sown situation, the medical staff satisfaction on the electronic clinicalpathway is70%to100%, the overall satisfaction rate is88.75%.Conclusions：1.The electronic clinical pathway can carry out standardized real-timemonitoring, the integrated design with the HIS system can save the costsand time of system maintenance; The electronic clinical pathway haveflexibility configuration and high availability, can improve health carequality and safety; the electronic clinical pathway can manage variationconveniently and save medical staff work time. 2.The practicality and scalability of the electronic clinical pathway arepowerful，The medical personnel satisfaction is88.75%; to promote theimplementation of the electronic clinical pathway, need to balancingquality standards of the clinical pathway and restrictions on a coctor’spermission, in addition to need to supplemented by administrativemeasures.3. With the rapid development of IT industry, the development ofelectronic clinical pathway is a inevitable trend of the development ofelectronic medical records system.