| The Clinical pathway (CP) is formulized standard clinical care plans for specificdiseases or surgeries based on scientific evidences and best practices aiming at improvingthe quality and efficiency of healthcare, while controlling care risks. The expected effectshave been approved by domestic and international practices. In recent years, nationalhealth authorities have been actively advocating and promoting the application of the CP,and a number of CP for specific diseases have been formulated and issued. Although thereare a lot of hospitals adopt clinical pathways for purposes of regulating clinical behaviorof the medical staff, reducing waste of medical resources and providing more safe andefficient medical services to their patients, applying clinical pathways widely is still facingmany difficulties and obstacles. Many hospitals, especially small and medium sized oneshave not carry out clinical pathway yet. In order to make the majority of patients fromareas of the far and the poor enjoy the benefits that clinical pathways offer, there is animportant practical significance to observe the current situations of clinical pathwayapplication and explore the existing impeditive factors, and then to identify measuresshould be take to promote the implementation of CP. This study takes clinical pathways of Senile Cataracts as an example, based on theexcision combined intraocular lens implantation for cataract surgery clinical pathwaywhich issued by the National Health and Family Planning Commission of the People’sRepublic of China, and two specifications of the clinical pathway developed and usedrespectively in two large tertiary hospitals of southwest (hospital A) and northwest(hospital B). Meanwhile, a hospital in northwest (hospital C) was taken as therepresentative of small and medium-sized hospitals that have not applied the CP. With theactual clinical activities for cataract in hospital C as the research object, this studyidentified gaps of clinical processes among hospital C, A, B and the standard clinicalpathway, summarized the factors that hinder the implementation of the clinical pathway,and put forward corresponding measures and suggestions.1. Contrast and analyze the differences of the clinical pathway between hospital A,B and the standard clinical pathway, revealing the variations in clinical process and thestatus of clinical pathway implementation.2. Compare the clinical processes of hospital C with standard clinical pathway andhospital A, B, representing the standardization degree of clinical processes in hospital C.3. Extract and analyze the data of senile cataract patients discharged from ofhospital C during2010-2012, trying to find the impact of non-medical factors such ashealth insurance policies in clinical decisions.4. Interview relevant personnel of hospital C, and summarize the factors affectingthe implementation of clinical pathways from aspects of national health policy, hospitalmanagement system, and medical staff and patients experiences.The main results of this study:1. Differences of clinical process exist between the standard clinical pathway andthe two hospital specifications. There are also variations between hospital A and B.2. Compared with the standard clinical pathway and the hospitals which implementthe path management, clinical process in hospital C is not rational enough with problemssuch performing unnecessary medical observations and overusing of antibiotics. 3. The patients’ health insurance type, payment methods directly affect the doctor’sclinical decision. Drug charge of patients who pay by themselves is47.9%of total hospitalcosts, which is significantly higher than that of patients covered by medical insurance.4. Physicians’ awareness of clinical pathway needs to be improved, and there areprofit-driven behaviors in clinic activities. Hospital managers pay little attention to clinicalpathway, and hospital regulations and technical conditions do not fully meet the hospital’sclinical pathway implementation requirements. Patients’ involvement in their medical careis insufficient, and medical decisions depend mainly on doctors.The main conclusions of this study:The current national health care system is the major obstacle to the implementation ofclinical pathways, leading to negative patterns in hospital management and clinicalbehaviors. Therefore, reforming the national health service system with quality, efficientand equitable healthcare delivering mechanisms should be accelerated. Meanwhile,hospital administrators should be more acknowledgeable to clinical pathways and medicalpersonnel be more qualified professionally and ethically so as to establish a favorablehospital environment for implementing clinical pathways. |
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