| ObjectiveThe basic situation of 6 county hospitals, the implementation of clinical pathway and the patient’s medical record information were collected in Henan province, to analyze the changes of related indicators of five diseases brought into clinical pathway management. It can be used to evaluate the implementation and effect of clinical pathway in county hospitals, and to explore the effect of clinical pathway on hospitalization days and medical expenses. It can be used to provide fundamental research data for the application of clinical pathway in county hospitals.MethodsSix county hospitals included in the clinical pathway management from Henan province were selected as sample hospitals in the study. The inpatients of five diseases with the same standard of diagnosis, therapy methods, enough sample size, and comparable features between groups were selected as study subjects from six county hospitals between January 1, 2015 and June30, 2015. The control study of patients with cerebral infarction, transient ischemic attack, bronchial pneumonia, planned cesarean section and senile cataract were managed as a trial group with clinical pathway between January 1, 2015 and June30, and patients with same diseases and comparable features who stay in the control hospitals were managed as a control group at the same time. All the data from medical records of hospitalized patients in hospitals, including patient name, gender, age, disease name, admission conditions, medical insurance conditions, time of operation, length of stay, total hospital costs, drug costs, clinical treatment expenses, examination expenses, nursing expenses and other information. The evaluation indexes were hospital days, total hospitalization costs, drug costs, proportion of medicine, clinical treatment expenses, examination expenses, nursing expenses. Qualitative data were described as frequency and hypothesis test were performed with χ2 test Fisher’s exact probability; the quantitative data were described as mean and standard deviation, and statistical inferences were conducted with t test. The software SPSS was used to analyze all statistical data, and the two-side significant test level was set up as α=0.05.ResultsIn this study, 1275 patients of 5 diseases in trial group with clinical pathway were randomly selected between January 1, 2015 and June30, and 1299 patients with same diseases as control group without clinical pathways between January 1, 2015 and June30. There was no statistically difference with age, gender, admission conditions, medical insurance conditions between groups(P>0.05).To the length of stay in hospital, the average length of stay in trial group was lower than that in control group. The average hospitalization days of cerebral infarction of patients in trial group with clinical pathway was shorter than that of patients in control group(10.04 vs. 11.32, P=0.001), the average hospital days of transient ischemic attack(9.05 vs. 10.91, P=0.004) and senile cataract(2.34 vs. 3.01, P=0.006) of patients between groups were statistically difference. There was no significant difference with hospitalization days of patients of planned cesarean section between groups(P>0.05).To the cost of hospitalization, the total hospitalization costs of 5 diseases in trail group decreased to different extend compared to control group. The average hospitalization costs of cerebral infarction patients in trial group were statistically difference from that of patients in control group(4714.44 yuan, 5289.02 yuan, P=0.002), and the average hospitalization costs of transient ischemic attack patients were different between groups(3768.93 yuan, 5316.83 yuan, P=0.013), and average hospitalization costs of bronchial pneumonia(1966.15 yuan, 2170.08 yuan, P=0.001), planned cesarean section(3468.39 yuan, 3544.25 yuan, P=0.042), senile cataract(1713.38 yuan, 1943.62 yuan, P=0.001) between groups were statistically difference, respectively. In addition to the planned cesarean section, 4 diseases of clinical treatment costs, nursing fees, examination expenses in trail group were lower than that in control group.The average drug expense of patients in trial group was lower than that of patients in control group. The average drug expense of cerebral infarction(1984.31 yuan, 2250.74 yuan, P=0.003), bronchial pneumonia(841.34 yuan, 946.12 yuan, P=0.001), planned cesarean section(481.06 yuan, 551.25 yuan, P<0.001), transient ischemic attack(1683.18 yuan, 2331.78 yuan, P=0.011) of patients in trial group was statistically difference from that of patients in control group, while there was no statistical difference of senile cataract between groups.ConclusionsTo the length of stay in hospital, it can shorten the average hospitalization days of patients and surgical patients before the operation after applying clinical pathway. Also, it can improve the health resource utilization and work efficiency in hospital.To the cost of hospitalization, the implementation of clinical pathway can reduce the hospitalization costs and drug costs of patients. It can reduce the waste of medical resources and control the excessive growth of medical costs.However, the clinical pathway has no effect on the outcome of patients with single disease, and there are no differences between the two groups in the individual indicators of some diseases. |
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