Study Estimates The Cost Of Eye Care Based Clinical Pathways

ObjectiveTo analyze the difference between the actual cost and charge, the research defines the nursing service content in the glaucoma clinical pathway, and calculates the nursing workload and the service cost in the glaucoma clinical pathway. The research can optimize the nursing process, provide the reference to utilize human resource scientifically and reasonably, and even offer scientific basis of charging standard with nursing service for the government decision-making department.Research methodsTo design the consultation questionnaire of the nursing service in the glaucoma clinical pathway by referring to the relevant policy standards and literatures and the primary glaucoma clinical pathway nursing standards which are listed in the book named ’the ophthalmic clinical pathway’, finally the glaucoma clinical pathway nursing projects will be established through the expert consulting method. The field investigation method is used to measure the execution time and required personnel of the nursing service, and to record the project time and frequency during the24hours which the nurses spend on each nursing project according to the pathway service process. The study object is sample of336primary glaucoma patients which are admitted into clinical pathway from January to July in2012in a third rate ophthalmology hospital in Shan Xi Province. The EXCEL2003and SPSS13.0is used to data entry and analysis.Results1. A total of.50nursing items are finally defined in the glaucoma clinical pathway, including31direct care projects and19indirect nursing services. The quantitative reliability analysis of the questionnaire are as follows:the effective recovery rate of the questionnaires in the two rounds expert consultation are both100%, which reflects the experts’ great enthusiasm; the authority value is0.79(>0.7), bigger than0.7, showing that the22experts have good authority, which guarantee the credibility of the consulting results.2. The top five time-consuming single-pass care programs are these which refer to assisting patients to complete ophthalmologic examination or operation, and also the hospital discharge, health education and life guide, evaluation and measures formulation respectively. Due to operating frequency differences among these single nursing service during the whole clinical pathway, the most time-consuming program is eye dropping, the second is health education and life guide, the third is life care, then life-sign measurement and patient rounds are the forth and the fifth order respectively. Health education and life care belong to direct nursing service, the time spending on them constitute about26%of the total nursing workload.3. In different stages of primary glaucoma clinical pathway, the nursing workload is different. The heaviest workload often appears in the pre-operation day or hospital discharge day. Whenever at this time, the nurses always work overtime. So the nursing course during the discharge phase needs a more effective management, which will be finished under multi-party cooperation, such as pharmacy, admission office and health care center etc.4. If the length of stay is six, the receivable nursing cost in the primary glaucoma clinical pathway is450yuan, but the actual patient care fee is151yuan. Among the50nursing project, only14items are rechargeable. However, the items, such as eye drop, life care and health education which often are operated high frequently and related to ophthalmology patient care quality directly, are gratis. So the ophthalmic nurse fees structure is not reasonable, it cannot really reflect their practical work.Conclusions1. In the current nursing mode, if the nursing staff provide patients with continuous, full of care and professional technical services in accordance with the requirements for high quality nursing service, the nursing workload is huge, but the human cost is the main component of nursing cost. Therefore, the hospital managers should formulate the nursing process scientifically, save the human cost, and optimize the clinical nursing care quality processes and human resources configuration, which plays an important role in improving the quality of nursing service and nursing cost.2. The results show:glaucoma clinical nursing path cost is far greater than the current charge, and the ophthalmic nurse fees structure is different from their practical work, so the current charging standards can not reflect the real care value. The countries decision-making government departments should draw up charging standards reasonably, according to the current actual situation of nursing work, so as to manifest the value of nursing work adequately.