Evaluation On The Implementation Of Hospital Representative Diseases Clinical Pathway

Background: Building comprehensive evaluation index system from the clinicalpathway and evaluating it. It has great significance to improve health care quality,standardized medical practices, reduce medical costs, shorten hospital stay, and promote thestandardization and process of clinical pathway.Objective: The study chooses eight representative diseases in sample hospital that usesclinical pathway, build evaluation index system from the perspective of conditions ofimplementation, processes, outputs, outcomes, impact, and evaluate representative diseases.On the basic of these, analyze the effect and problems of the implementation of the clinicalpathway; provide recommendations for further refining and improving the hospital’s clinicalpathway.Methods: Qualitative Analysis: investigation is used to collect clinical pathwayinformation; Delphi method is used to establish evaluation index system; descriptive analysisis used to analyze the index of conditions, process and output; Quantitative analysis: Therank test is used to analyze the changes of major medical quality indicators and costindicators before and after implementation of clinical pathway; factor analysis is used toanalyze the doctor-patient satisfaction; using multiple linear regression analysis is used tolearn affecting factors after the implementation of clinical pathway. Results:1.Using the Delphi method to establish comprehensive evaluation system of clinicalpathway, including the five first-level indicators: conditions, procedures, results, etc.;14secondary-level indicators: system security, the implementation of clinical pathway, quality ofcare, the economic effects;24third-level indicators: develop management system, a cleartimeline, the average length of stay, costs.2.Compared with the no implementation of clinical pathway, indicators changes ininguinal hernia, thyroid tumor, respiratory infections, hand-foot-and-mouth disease，type Ⅱdiabetes, tonsillitis, calculous cholecystitis and myoma of uterus as follows: average length ofstay: except respiratory infections, the others decreased; cure rate index: except inguinalhernia, others increased; fee per time indicators: except thyroid tumor and respiratoryinfections,others decreased; daily cost indicators: except hand-foot-and-mouth disease andinguinal hernia, others were elevated; fee of medicine per time indicators: exceptrespiratory infections, the other decreased; proportion of medicine fee per time in fee of pertime: except type Ⅱ diabetes, tonsillitisand hand-foot-and-mouth disease, the otherdecreased; fee of assay per time indicators: except respiratory infections, the other decreased;proportion of assay fee per time in fee of per time: except type Ⅱ diabetes,hand-foot-and-mouth disease and respiratory infections, the other decreased. After anon-parametric Wilcoxon test, values of P of above indicators were greater than0.05, thedifference was not significant.3.The score of staff and patient in sample hospital on clinical pathway are2.113points,2.023points respectively. They are less satisfied with it.4.Using multiple linear regression to analyze the factor of clinical pathway, with totalcost of hospitalization as the dependent variable, the number of days of hospitalization, drugcosts, inspection fees, inspection fees, supplies expense, days of using of antibiotics, anddischarged as the independent variable, analyze eight diseases respectively, common factors that affect the cost of control are: drug costs, supplies costs, inspection fees, assay fees.Dependent variable and independent variable are positively correlated, and the difference issignificant. It proves that clinical pathway not only regulate medical practices but controlmedical costs.Suggestions:1.Improving the daily management of the clinical pathway process, and graduallyrealize scientific;2.Implementing the quality control management and risk assessment related to thedevelopment of clinical pathway;3.Controlling health care costs from drug costs, supplies costs, inspection fees, andinspection fees;4.Improving satisfaction from the greatest concern of issues that affect the doctor-patientsatisfaction with clinical pathway;5.Strengthen coordination and cooperation between the various hospital departments,improve teamwork and cohesion;6.Establishing appropriate compensation payment and security systems;7.Forming an effective performance appraisal system;...