| Background: It is well known that expensive medical treatment is the hotspot of health care. In January 2011, the National Health Minister zhu Chen said it was necessary to control the excessive growth of medical costs as an important task of public hospital reform task.Therefore, from the perspective of the hospital economic management model to analyze the causes of rising medical costs, and to explore effective management mode to reduce the operating costs and control medical costs, so we can reduce the economic burden of patients. There is cheap cost behind the high-quality service, it can improve patients’ satisfaction, attendance rates will increase, it has practical significance to the hospital [1].In the early 1980’s, for the same problem, the United States took the lead in the implementation of diagnosis related grouping legislation for payment based on a fixed prepayment system(Diagnosis Related Groups-Prospective Payment System, DRGs-PPS) to improve the utilization of health resources, inhibit constant rising health care costs. On this basis, Boston, Massachusetts, New England Medical Center firstly put clinical pathway(Clinical Pathway, CP) to clinical management, and proved it can short the length of stay and cost savings [2 ] [3], and didn’t affect the treatment effect. The definition of clinical pathways of Ministry of Health of China is doctors, nurses and other professionals for certain diseases or surgery, on the basis of evidence-based medicine basis, in order to improve the medical quality, control the medical risk and improve the utilization efficiency of health resources. For the purpose of making a strict work order and precise time requirements of procedural and standardized diagnosis and treatment plan, to standardize the medical service, less waste of resources, so that patients receive appropriate medical care services. Year 2010, China’s ministry of health for disease to develop the clinical path forms, and have started to pilot clinical pathway management, combined with the progress of medicine, adjust the inadequacies of the implementation details of the path, with regard to provide optimal treatment, and benefit the patients.Mammotome(MMT) vacuum-assisted minimally invasive breast biopsy system developed by the United States in 1994 [4] and was mainly used in early breast positioning biopsy of suspected lesions [5], and then is mainly used for breast tumor biopsies and the minimally invasive resection of benign neoplasm, with its high diagnostic accuracy, high removal efficiency, less invasive, better cosmetic effect, is widely used in many countries and regions [6]. Department of our general surgery carried out the Mammotome breast surgery in 2006.12, either resection or biopsy has good clinical effect [7].In 2012.4, our hospital clinical pathway management committee and the instruction evaluation groups accorded with the guidance of the Ministry of Health Evaluation Group and general requirements for the rear of the Ministry of Health clinical pathway management, combined with the actual situation of our hospital, chose the larger capacity, higher costs, relatively clear treatment programs, medical technology is relatively mature, and the treatment process variation small part of common, standard reference path Ministry of Health, made to adapt to the various departments of clinical pathways, combined with electronic medical records system. They contain Mammotome breast benign tumor resection surgery(referred breast masses atherectomy) clinical pathway. General surgery department implemented a clinical breast masses path atherectomy in 2012.6, now we evaluate the effect of the path analysis.Objective: By comparing the clinical pathway under the breast masses atherectomy with no clinical pathway Mammotome operation to analyze the advantages of clinical pathways, and provide evidence and recommendations for the implementation of clinical pathways of breast masses atherectomy. Methods: Take the Shenyang Military Region General Hospital electronic medical record integrity, and our department carried out clinical pathway atherectomy breast masses in 2012.6 into consideration, choosing from 2012.6 to 2012.10 the discharge diagnosis of benign breast tumor which were included in the clinical pathway of breast masses atherectomy as path group, 2010.1 – 2012.5 during the discharge diagnosis of benign breast tumor which are under Mammotome as control group. All patients were excluded Patients with bilateral lesions. Chose randomly each group of 100 cases to study. Two groups of patients were female patients without gender differences; there are no statistical significance(p> 0.05) differences in age, tumor size, number of tumor and tumor ultrasound BI-RADS classification, two groups are comparable. Path group is in strict accordance with the clinical pathway in breast tumor atherectomy procedures prescribed daily treatment of solid work; control group, previous inspection, treatment and hospitalization days have not been uniform regulations. The average preoperative, postoperative and the total number of days in hospital, the incidence of postoperative complications, the patients’ compliance and satisfaction were analyzed.Results:(1) The average total cost, average hospitalization preoperative group and total hospitalization days path group were lower than those in control group(p < 0.01);(2) The postoperative hospitalization days, the postoperative complications in the two groups had no difference(p > 0.05);(3) The patients’ compliance and satisfaction path group was obviously higher than control group(p < 0.01);(4) There were no drop in path group, but negative variation are 3 cases(3%). Conclusion: Breast tumor atherectomy clinical path can reduce health care costs, shorten hospital stay, improve patients’ compliance and satisfaction, and to standardize medical procedures, improve physician efficiency, ease patients and doctors’ relationship, so that it reflects a patient-centered management philosophy. Its high-quality, low-cost service purposes are consistent with the needs of China’s national conditions, have important practical significance. Clinical pathway is a scientific and effective medical management, and has feasibility and extension. |
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