Comparative Analysis Of Effect Of Clinical Pathways Model On The Medical Expense And Hospital Stay

ObjectiveA study on effects of application of clinical pathways mode on nodulargoiter quality management, to find out and compare the main influential factorsof medication cost and hospital stay between clinical pathway group andnonclinical pathway group. And according to the factors, the resolution were inorder to reduce medical expense and optimize the clinical pathway. At thebase of that,we can reduce the clients’ heavy burdens and control the medicalexpense’s excessive growth, to provide the basis of feasibility for moreeffective use of health resources and enhance applications of clinical path.MethodsTo use the quantification method retrospective clinical case studymethod,using Crossing cluster sampling to extract experimental group(clinicalpathways group)128cases who diagnosed as nodular goiter with thethyroidectomy and executed clinical pathway in strict rotation from August2010to March2011, and control group (traditional therapy group)130cases fromDecember2009to July2010.We retrieved and collected the clients’ nosocomialdiagnosis and treatment data,to compare and analyse the average length ofstay in hospital,medical cost,complication and adverse effect incidence ratio,postoperative recover relevant index and to establish stepwise selection modeland compare the main influential factors of medication cost and hospital staybetween two groups. Therefore,we measure clinical pathway quality management effectiveness and propose improvement plan.ResultsStatistics show that the two groups have no significant difference inage,gender, expense,duration of disease, accompanying symptoms(coughbecomes short-winded, dysphagia,hoarseness,dyspnea,etc),diseased region,complication,etc,which explained that the two group have comparability. Tocompare with control group,in the experimental group,the average length ofstay was shortened and complication and adverse effects were reduced.Postoperative recover relevant index showed well and medical care qualitywas improved,while cost has little effect(P>0.05). Concretely,the averagehospital stay of the experimental group(7.78±1.13d) is shorter significantlythan that of the control group(9.35±2.53d),(P<0.001). The two groups havesignificant difference in preoperative and postoperative time,operative timeand anesthetic test time(P<0.001),which showed that clinical pathway controlplay an important role in reducing expense from admission to discharge fromhospital. In the compare of postoperative recovery relative indicators, the twogroups have significant difference in postoperative time of geting down frombed, tube drawing time, stitches removing(P<0.001). The two groups’incidencerate of complication and adverse reaction were13.85%and22.66%, thechi-square test showed they have statistical significance(P<0.05) and theclinical pathway group have low incidence rate.In the fact of two groups’cost,after the application of clinical pathway,the cost has declined354.62RMBon average(P<0.05),which showed the clinical pathway’s economical benefitand alleviate patients’ economical burden.As to the cost’s constitution,the totaloperation fee had no change,but the material fee,as one part of total operationfee,showed a high tendency.The medicine fee had a slight decrease but hadno significant change(P>0.05),which showed control power should beimproved.Besides the every bed’s daily fee,treatment fee and test fee all havebeen increased largely(P<0.05),which possiblely be related to the decrease of clinical pathway’s stay and the normalized process.The result of thisinvestigation also showed that in clinical pathway group,the main influentialfactors of medical charge are age,preoperative complication and perception ofmedicine.Compare with the nonclinical pathway group, the factors of hospitalstay and expense payment method had never been the factor of clinicalpathway cost.The main influential factors of clinical pathway hospital stayincluding age,preoperative complication and utility time of antibiotic.Comparewith the nonclinical pathway group, except the postoperative complication andexpense payment.ConclusionsClinical pathway management is the eidence-based and continue improveprocess.Optimize the clinical pathway is the best way to accomplish clinicalpathway effective management.Therefor,we should continual optimize theclinical pathway to improve our service for clients.The data analysis showedthat clinical pathway played an important role in the course of nodular goiterquality management, especially in the aspect of the average length of staydiagnosis and patient’s expense and treatment effect and every bed’s dailyfee.The control point should furthermore focus on the medicine usage andmaterial cost.Meanwhile we should transform the uncontrollable factors suchas complication and age to the controllable factors.We can establish pathwaytyping management and outpatient common complication management,whichis not resolved by hospital only,but the whole society anticipate and nationalpolicy support are also important.Effective health revolution measure shouldbe researched and investigated.Meanwhile enhancing the medicinesupervision management aimed to decrease medication expense and patient’sburden and effectively utilize medical sources. At the same time,throughinnovative clinic study, it is capable to provide a practical and cost-savingcuring methods suitable for the patients.