Implementation Of The Clinical Pathway For Colorectal Polyps And Application Of PDCA Circulation

Objective:Colorectal polyps are common diseases of the digestive system,the clinical manifestations are non-specific,adenomatous polyps of the pathological classification and colorectal cancer is closely related,so adenomatous polyps are known as precancerous lesions.Since the advent of digestive endoscopy,the detection rate of colorectal polyps increased.Early detection and early intervention can reduce the incidence of colon cancer.So how to regulate the treatment of colorectal polyps become a hot research in recent years.Clinical Pathways are defined as structured multidisciplinary care plans which detail essential steps in the care of patients with a specific clinical problem.It can effectively control the medical expenses,rational use of medical resources,reduce medical costs and standardize treatment.However,there are still some problems in implementation process.This study explores the effects of the clinical path of colorectal polyps and the problems in the implementation process.The PDCA cycle is applied to the clinical path management,and the specific improvement measures are put forward for the corresponding problems,and continuous quality improvement.Methods:A total of 1056 inpatients with endoscopic polypectomy on colorectal polyps were enrolled in the Department of Gastroenterology,the First Hospital of Jilin University.Among them,102 patients one year beforethe implementation of colorectal polyps' clinical path as the control group,763 patients with completing colorectal polyps' treatment in clinical pathway were enrolled as clinical pathway group,and 191 patients were exit the path.Preoperative hospital stay,total length of stay,total hospitalization,medicine,drug ratio,bed fee and special care fee,patient satisfaction of the two groups were observed.Compare the two groups of indicators and the trend of the years after the path to understand the effect of the implementation of the path,according to the trend of exploration to explore the various aspects of the path problems.At the same time,analyze the causes of variation outside of clinical pathways,and use PDCA circulation to improve the path continuously.The data were expressed by median and quartile numbers,and the differences among the groups were compared using the Kruskal-Wallis H test and the Mann-Whitney U test.For the classification data,using the number of cases and the proportion of the description of its distribution,and using chi-square test to compare the differences between groups.Results:Compared with the control group,the total hospitalization,medical expenses,drug ratio,bed and special care fee of the clinical pathway group were lower.Preoperative hospital stay and total length of stay were shorter than that of the control group.The satisfaction rate of clinical pathway group was significantly higher than that of the control group.The difference was statistically significant(P < 0.05).The total hospitalization and medical expenses in the general polypectomy group decreased gradually the year after 2011,after the increasing from 2010 to2011.Compared with the previous four years,from 2014 to 2016,bed and special care fee increased higher than before.There was no statistically significant difference among the years in the total length of hospital stay and preoperative hospital stay,but the mean value showed a decreasing trend.The total hospitalization and medical expenses of the EMR group decreased gradually.Compared with the previous three years,from 2014 to 2016,bed fee and special care fee increased higher than before.And total hospitalization day gradually shortened,there were statistically significant differences among the years(P<0.05).There was no statistically significant difference in the length of hospital stay among different years(P= 0.553),but the average showed a downward trend.A total of 954 patients were selected for clinical pathways,among them,191 patients exit the path,and the total variation rate was 20.02%.The variation rate in 2011 was lower than that in 2010,and increased in 2012 compared with the previous two years.After the management of the path,the mutation rate gradually decreased.Conclusion:Through this study can be concluded that the clinical path can effectively control hospitalization,shorten the hospital days and increasepatients' satisfaction.PDCA cycle theory can be applied to clinical path management,which can be continuous quality improvement.It is an effective management model for clinical pathways.