| Objectives:To assess the implementation effects of clinical pathways (CPWs) in patients undergoing uterine fibroids operations quantitatively and analyze the cognitive status of medical personel on CPWs. Founding problems and giving some suggestions and evidences to help government and involving departments promote and implement CPWs.Methods:1. Effects of CPWs in Patients undergoing Uterine Fibroids Operations:The Cochrane Library, PubMed, EMBASE, Web of Science, Chinese Biomedical Literature Database, CNKI, Wanfang Database and VIP were searched to select randomized controlled trials (RCTs) on CPWs used in patients undergoing uterine fibroids operations. Selecting studies, assessing risk of bias and extracting data of included studies were conducted by two reviewers independently. Jadad was used to estimate the quality of included studies and meta-analysis was conducted by RevMan 5.1 software.2. Investigation of Cognitive Status of CPWs Medical Personel:Using questionnaire to survey medical personel in Gansu provincial hospital, Lanzhou University First Hospital, Lanzhou University Second Hospital and clinical medicine postgraduates from Lanzhou University and Gansu University of Chinese Medcine. The survey content includes theoretical knowledge, practical situations and department application conditions. Epidata and SPSS 17.0 were used and Logistic Regression, Chi-square Test and Fisher’s Exact Test were used to conduct statistical analysis.Results:1. Effects of CPWs in Patients undergoing Uterine Fibroids Operations:10 studies were included. The aggregate overall results showed that a shorter average length of stay [MD=-1.61; 95%CI (-1.91,-1.31); P< 0.00001] and days of waiting for surgery [MD=-0.75; 95%CI (-1.06,-0.44); P< 0.00001] were associated with CPWs. Reduction in inpatient expenditures was observed in CPWs compared with usual care [MD=-1197.69; 95% CI (-1582.04,-813.35); P< 0.00001]. Higher score of patient satisfaction was also found in CPWs.2. Investigation of Cognitive Status of CPWs Medical Personel:690 valid questionnaires were returned, including 510 medical personel (doctors 260, nurses 208 and managers 42) and 180 postgraduates.① Awareness rate of CPWs was 83.5%. Comparision among medical personel showed that more doctors knew CPWs than nurses (x2=28.464, P<0.0001) and managers (χ2=23.908,.P<0.0001) respectively. ② Factors influenced awareness rate of CPWs:Only job categories (P=0.008) influenced awareness rate of CPWs. gender, age, education level and professional title had no influence on it. ③ Whether participated in CPWs training or not:41.3% responders have participated training. There were 54.3%medical personel participated. Doctors were 65.3%, nurses were 38.2% and managers were 50.0%. Statistical significance exist among them (χ2=28.159,.P<0.0001). In addition,34.2% postgraduates participated. Gansu University of Chinese Medicine was 34.7%and Lanzhou University was 34.0%. There was no statistical significance between them (x2=0.007, P=0.933). ④ Factors hindered the implementation of CPWs: There were 67.4%doctors,64.3% nurses and 53.6% managers chose complicated operation process. No statistical significance exist among them (χ2=2.217, P=0.330).Conclusion:CPWs could improve the quality of care in patients undergoing uterine fibroids surgery, which were associated with a significant reduction in average length of stay and days of waiting for surgery, a decrease in inpatient expenditures and an improvement in patient satisfaction. As an effective medical management mode, CPWs should be widely promoted in the surgical treatment of uterine fibroids. In addition, although awareness rate of CPWs was high, grasp of theoretical knowledge was not well. Propaganda and training of CPWs need to be strengthened. In addition, complicated operation process was the main factor hindered the implementation of CPWs. Therefore, government should improve the formulation and implementation of CPWs to promote it in China. |
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