| Objective:The standard management for clinical pathways base on Traditional Chinese Medicine (TCM) was carried out, to assess the effectiveness of clinical pathway for patients of Chronic Heart Failure (CHF), including medical efficiency, expenses and quality, as well as the partition of traditional Chinese medicine, and to optimize the process of diagnosis and treatment of TCM for patients of CHF, give suggestions for the reform of health system in the medical treatment pay model. Furthermore, hope to reduce the waste of the limited medical resources.Methods:Under the guiding document TCM clinical pathway for24Professions and105diseases (State Administration of Traditional Chinese Medicine,2011), and combined with existing clinical treatment programs, literatures and expert consultations, we developed a best treatment model of clinical pathway for chronic heart failure, which full in TCM characteristics, including develop a detailed evaluation and the standardized clinical pathway forms, implementation process, implementation regulations and management systems, as well as set up a implementation team and assessment team, and the staff training for clinical implementation team. The patients of CHF that met the inclusion and exclusive criteria in People’s Hospital of Fujian University of Traditional Chinese Medicine in2013, were divided into clinical pathway group and the retrospective group. And the effects on medical quality, clinical efficacy, medical expenses and indicators of TCM features were assessed.Results:Results of the study showed that:the hospitalization time was significantly shorter in the pathways group than in the retrospective group(13.48days vs11.50days, p<0.05), and the average total cost of hospitalization was significantly reduced in the pathways group(￥9509.32vs￥11011.17), showing statistical difference(p<0.05), the charge of western medicine was also reduced from￥4330.27to￥3626.32(p<0.05), Chinese herbal medicine fee was increased from￥166.07to￥218.47(p<0.05), the examination fee was significantly reduced in the pathways group(￥3278.28vs￥3408.88, p<0.05), but the cost of Chinese patent drug has not dramatically different from two groups. The level of NT-proBNP were significantly reduced in both group, pathways group was reduced from2494.78pg/ml to1165.07pg/ml(p<0.05), and the retrospective group was reduced from2830.52pg/ml to1627.12pg/ml(p<0.05), which was showing no statistical difference in two group(p>0.05). Moreover, the effect on the heart function was better in the pathways group than in the retrospective group(the total effective rate:98.33%vs95.00%),showing statistical difference(p<0.05). All of patients satisfaction about treatment, clinical effect and the overall of medicine service in pathway group were100%, while the retrospective group were96.67%、100%、98.33%, respectively. Furthermore, the participation rate of Chinese herbal medicine in pathway group was100%, better than the retrospective group (88.3%, p<0.05).Conclusions:1. Implementation of TCM clinical pathway in patients of CHF, could significantly shorten the shorten the hospitalization time, decreased the cost of hospitalization, ensured the medical quality and enhance patient satisfaction.2. Implementation of TCM clinical pathway in patients of CHF, would increase the participation rate of herbal medicine, and made the TCM play a more important roles in the treatment. |
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