A Research On The Medical Quality Eval Uation Of A Third-Level1st Class Hospital Ba Sed On Clinical Pathway

Currently, the clinical pathway is a pilot country, the health administrative departments at all levels attach great importance to medical institutions and pilot work, the use of clinical pathways to improve health care efficiency, improve quality of care, control unreasonable medical expenses has become the consensus of medical managers. In this study, analysis and evaluation of clinical pathway results in a first class Hospital of WuXi, hopes to establish the effect of clinical pathway evaluation model for the Hospital, Which promote clinical pathway for process monitoring, timely detection problems, suggest improvements and suggestions for the systematic and comprehensive analysis of the health administrative departments to assess the effect of the pilot clinical pathway to provide data for reference.Objective(1) results through the implementation of clinical pathways analyzed whether the behavior observed in clinical diagnosis and treatment has been standardized, efficient medical care, health effects, health benefits and other indicators without improvement.(2) To explore, establish and perfect fit the first class Hospital of Wuxi of actual clinical path management system, operating mode, operation mechanism and quality assessment and continuous improvement system to provide basic research data.(3) The first class Hospital of Wuxi, the fourth single Medicare DRGs full implementation of the system, such as the cost of providing basic research data.(4) Provide analysis for the health administrative departments to assess the implementation of clinical pathways, develop and improve policies and systems provide the basis of clinical research data path. Methods(1) This paper applies the method of baseline survey, based on clinical path way management information system as the basis to determine the first class Hospital of Wuxi, base data collection2009,2010,2011and three years,using simple random sampling method selected a certain number of single disease medical records from the clinical path management system as sample.In the data processing and analysis, mainly using the following methods:(1) The application SPSS190statistical software-based, excel spreadsheet, supplemented; data (2013) and baseline data (2009,2010,2011) after the implementation of clinical pathways to compare the clinical pathway analysis observed changes in indicators.(2) The Ministry of Health study reference implementation of clinical pathways related to data collection requirements, index calculation, using analysis of variance, chi-square test, non-parametric test (significance level a=0.05) and other statistical methods for analysis, which was observed16two sections of28disease after clinical pathway implementation effect.(3) Clinical pathway disease were selected from internal medicine, surgery and obstetrics and gynecology room mycoplasma pneumonia, breast cancer, uterine fibroids, chronic nasal-6sinus disease, planned caesarean section, the focus of nodular goiter and so do statistical analysis, outcome measures changes.ResultsFrom the efficiency of the quality indicators, the average number of days hospitalized before the implementation of the overall implementation of clinical pathways clinical pathway significantly lower than the chronic nose-sinus after the implementation of the clinical pathway prior to the date of hospitalization compared with an average increase of0.52days to implement (P<0.05). After a few days in hospital before surgery the overall implementation of the clinical pathway prior to the implementation of clinical pathways significantly lower than the various clinical pathway disease with significant differences (P<0.05) between the average length of stay.From the effects of quality indicators, the overall cure rate than before the implementation of clinical pathways clinical pathway significantly increased, breast cancer before and after implementation of clinical cure rate compared with the implementation path reduces7.7%(P<0.05). The overall healed rate than before the implementation of clinical pathways clinical pathway reduces chronic nose-sinus decreased5.1%, nodular goiter decreased0.8%.After benefit from quality indicators, average medical costs overall implementation of the clinical path than before the implementation of clinical pathways significantly reduced chronic nose-sinus before and after the implementation of clinical pathways in health care costs compared with an average increase of2876.5yuan implementation (P <0.05). The overall average length of stay for a few days after the implementation of the clinical path than before the implementation of clinical pathways significantly reduced.Conclusion(1) Clinical pathway is the direction of the standard of diagnosis and treatment of medical quality management in hospital and the new medical mode. Clinical path to shorten the average days of hospitalization, hospitalization days before operation, reasonable control and standardize the average medical cost, and improve the cure rate for disease characteristics, design of medical and nursing care and the best solution according to different diseases, and hospitalization for patients according different patient time andcost effective control and reasonable arrangement. Diagnosis and treatment behavior which is not only the standard hospital in different disease, but also for the diagnosis and treatment behavior completion time, schedule and other aspects of the effective plan, to further promote the efficient use of medical resources.(2) The main problems existing in the process of implementation of clinical path: clinical pathway though the average hospital stay, preoperative hospital stay, the average medical expenses, the average hospitalization days, cure rate index has obvious effect, but in practice there are still some problems:â‘ Clinical path to strengthen the doctor-patient communication between the twosides, therefore, medicaldiagnosis scheme of the doctors to develop need to get patients and their families to sign, however, the asymmetry of information often leads to the patient not to cooperate and give up treatment;â‘¡The costs and benefits required for the implementation of the clinical path in the process of diagnosis and treatment of comple x diseases is unclear, and so is the effect. Since the individual differences between comp lex disease patients are relatively large, unified standard diagnosis and treatment scheme regulated in clinical path faces a great challenge in the implementation process.