Application And Variation Analysis Of Clinical Pathway Management In The Patients With Intracerebral Hemorrhage

Objective: The study investigates the influence of the clinical pathway(CP)management over the hospital time, cost and the treatment effect of patients withintracerebral hemorrhage and analyzes the variation occurred in the performance,providing some evidences for constantly improving intracerebral hemorrhage clinicalpathway.Methods: Grouping368patients with intracerebral hemorrhage from March,2008to December,2011into the CP group and non-CP group, with203cases from March,2008to March,2010as a non-CP group and the other165cases from April,2010toDecember,2011as CP group and inclusion criteria for cases of clinical pathway andsetting grouping of intracerebral hemorrhage clinical pathway of the Ministry of Healthin2009as the standard.The paper uses retrospective study to compare and analyze the impact of clinicalpathway management before and after its implementation over patients withintracerebral hemorrhage and its clinical significance. The following indicators of thetwo groups are statistically analyzed:(1) Medical expenses, including the hospital cost,drug cost, treatment cost, inspection fees and laboratory fees;(2) Health care efficiencyindicators: the average length of stay;(3) Health care quality indicators: treatment curerate, improvement rate, healed rate, mortality rate and complications rate;(4) Thedegree of recovery of the nervous system function: evaluation into the discharge GCS,NIHSS and BI index score;(5) Analysis of variation, including the analyses of the rate,nature and reasons of variation.Results:1. Length of stay comparisons before and after the implementation of the clinicalpathway: shorter stay in hospital after the implementation of the clinical pathway, one-day-long shorter from14days to13days, and in the two groups, p>0.05.2. The total cost obtained before and after the implementation of the clinicalpathway: after the implementation of the clinical pathway, total hospital costs increasedabout2090Yuan, while the drug costs fell, p>0.05, inspection fees, treatment fees, andthe laboratory fees increased, p<0.01.3. Intracerebral hemorrhage in patients with neurological defect degree of recoveryobtained before and after the implementation of the clinical pathway: GCS score,NIHSS score, and BI index score show no significant differences in both groups, P>0.05.4. Before and after the implementation of the clinical pathway in patients withdisease outcome cure rate has increased, the improvement rate, healed rate and deathrate have no significant changes in the two groups and show no significant difference,p>0.05;complications during hospitalization of patients has no significant changes inthe two groups and show no significant difference, p>0.05.5.After the implementation of the clinical pathway, the variability is36%. Themain reason of variations is patient variability, accounting for92%, followed byhospital variation accounted for8%. The main factors affect the variation of patients areprevious history of diabetes, intracerebral hemorrhage complications and admissionGCS score, NIHSS score and BI index score.Conclusions:1. The implementation of the clinical pathway on patients with cerebralhemorrhage has a positive effect to shorten the average length of hospitalization, reducethe proportion of drug cost in patients with intracerebral hemorrhage.2. Clinical pathway process variation causes mainly derived from patient-relatedvariability, multiple intracerebral hemorrhage corresponding complications. By logisticsregression analysis, it finds that the causes of variation are related to the history ofdiabetes of intracerebral hemorrhage patients, hospitalized complications and admissionneurological defect.3. Clinical pathway management has achieved a certain effect. It still needs tocontinue to improve management. It also needs to increase the sample size in thefuturedeeply study.