Study On Medical Quality Of Ischemic Stroke Based On Clinical Pathway

BackgroundAs a kind of measurable, standardized clinical guideline, clinical pathway can regulate and standardize the diagnostic and treatment practices, so as to more effectively utilize health resources and promote medical quality improvement. Implementation of clinical pathway, one of the important goals of health reform in public hospitals, is spreading vigorously all over the country. Meanwhile, with the continuous development of medical quality management, quality control and continuous improvement of medical procedures are paid more attention. Single disease quality management has become a trend in fine management of medical quality. However, the current evaluation of quality in medical procedures based on clinical pathway has not been effectively carried out, therefore it is impossible to perform objective and scientific assessment of the effectiveness of clinical pathway and achieve continuous quality improvement in medical care. Meanwhile, in order to enhance the quality management of single disease, National Health and Family Planning Commission of the People’s Republic of China (NHFPC) have released three batches of quality control indicators of single diseases, covering nine diseases and12kinds of quality control indicators such as prevention of perioperative infection and deep vein thrombosis. These indicators directly focus the quality of medical procedure. For those hospitals accustomed to the model of terminal quality management, they will be disoriented and face to many new problems in data gathering, indicators monitoring, data analysis and quality improvement. Research objectiveWe chose a common disease with high incidence (i.e., ischemic stroke), performed quality management study of single disease based on clinical pathway, and explored to establish a model of medical quality evaluation based on clinical pathway. We tried to combine the indicators of single disease quality management with management evaluation of clinical pathway, to test the effectiveness and scientific nature of the relevant indicators, and gather experiences in promoting clinical pathway and single disease quality management.MethodsQuality control indicators of single diseases issued by NHFPC were selected as the evaluation index to implement clinical pathway of ischemic stroke. According to the inclusion/exclusion criteria, ischemic stroke cases incorporated in the management of clinical pathway in2013were treated as intervention group, whereas ischemic stroke cases in2011were treated as control group. Relevant indicators data were derived from the hospital information system and medical records, and were compared with the reference data by analysis. The effectiveness and defects of clinical pathway were evaluated. Current industrial level of quality indicators was assessed by reference literature. The vulnerable points in clinical pathway management of ischemic stroke were analyzed. Special interviews with medical personnel participating in the clinical pathway management were organized. The difficulties in single disease quality management and implementation of clinical pathway were verified and suggestions for work improvement from medical staff were collected. Through evidence-literature interactive study, reasonable suggestions were made for further carrying out clinical pathway and single disease quality management. ResultsThere were655cases (average age:64.52years) and446cases (average age:64.87) meeting the inclusion criteria for intervention group and control group, respectively. In the intervention group, there were419male cases,236female cases; in the control group, there were269male cases,177female cases. Through the implementation of clinical pathway management, quality management of single diseases was effectively carried out in the diagnosis and treatment procedure. For the intervention group, the completion rate of nerve function defect assessment was48.1%,93.6%and87.2%, respectively at the emergency, admission and discharge, significantly higher than the corresponding data (0.0%,83.0%and71.8%, respectively) in the control group,(χ2=300.448.13.716.18.391, P=0.000、0.000.0.000).15.0%of patients received intravenous thrombolysis, higher than the data (6.1%) in the control group,(χ2=20.920, P=0.000).89.3%of patients in the intervention group received antiplatelet therapy within48hours after admission to hospital, higher than the percentage of82.3%in the control group,(χ2=11.193, P=0.001).96.5%of inpatients used statins, compared with70.6%of the patients in the control group,(χ2=1.475, P=0.000).97.7%of patients with LDL>2.6mol/L in the intervention group used statins, compared with74.9%of the patients in the control group,(χ2=70.579, P=0.000). The proportions of patients receiving risk assessment of deep vein thrombosis and secondary preventive measures were49.6%and30.7%, respectively, compared with24.0%and20.0%in the control group,(χ2=76.988、15.751, P=0.000.0.000).23.5%of the patients received early assessment and rehabilitation treatment in the intervention group, compared with13.0%in the control group,(χ2=18.840, P=0.000). Average length of stay of patients in the intervention group was10.95days compared with12.82days in the control group,(Z=-4.652, P=0.000), indicating improved utilization efficiency of medical resources. However, the indicator of clinical reception of stroke has not improved significantly, and the percentage of patients receiving blood vessel function evaluation within24hours after admission was still low. Compared with similar indicator data in the industry, the following indicators needing to be improved was as follows:the percentage of completing relevant inspections within45minutes after clinical reception, risk assessment and intervention for deep vein thrombosis, antiplatelet therapy after discharge, rehabilitation assessment and implementation. Compared with the corresponding level of hospitals in the United States, there is a relatively great gap regarding intravenous thrombolytic and anticoagulant therapy in patients with atrial fibrillation. Interview results and further analysis indicate that the investigated hospital during implementing clinical pathway of ischemic stroke, need to focus on optimization of diagnosis and treatment process, overcoming the bottleneck problems in auxiliary examination departments, further improving the informational level of clinical pathway management and paying more attention to the training among medical staff participating in the clinical pathway.ConclusionClinical pathway is an effective method for single disease quality management. It can effectively carry out the goal of single disease quality management, and promote quality improvement of medical procedures. At present, the informational level of clinical pathway and single disease management needs to be improved. Health administrative departments should strengthen the guidance for implementing single disease quality management, regularly evaluate and analyze the data of single disease quality control, and feed back the result to hospitals, so as to further promote the development of single disease quality management work.