| Objective: To take top-three hospital as an individual case,statistical analysis was conducted on the general data,average days of hospitalization,total hospitalization costs,and other indicators.To explore the effect of Henoch-chonlein Purpura when clinical pathway management is implemented in the sample hospital,guidance was provided for reference in clinical treatment when existing problems are discovered.In this way,we can provide a theoretical basis for the promotion of clinical pathway and improvement of clinical pathway management level.Methods: The hospitalized patients with complete Henoch-chonlein Purpura who were diagnosed and treated in our dermatology from September 13,2013 to February 02,2018 were selected as the research objects after knowing development status of clinical pathway at home and abroad by referring to a large amount of literature.According to the time of the implementation of the clinical pathway in June 2015,a total of 228 cases were divided into group before the implementation of clinical pathway(116 cases)and group after the implementation of the clinical pathway(112 cases).A total of 204 cases were effective after removing the 24 cases of automatic discharge,including 109 cases in the group before the implementation of clinical pathway and 95 cases in group after the implementation of the clinical pathway.Stratification was performed based on the five types of Henoch-Schonlein Purpura(simple type,joint type,abdominal type,kidney type,mixed type),and each type was divided into the group before the implementation of clinical pathway and the group after the implementation of the clinical pathway according to the time of the implementation of the clinical pathway.Statistical analysis was performed to compare the difference among the general information,average length of stay,total cost of hospitalization,drug costs,the proportion of drug costs,the regression days of rash,antibiotic utilization rate,days of antibiotic use,type of antibiotic use,and patient satisfaction.Results:1.General Information:(1)Gender: 59 males and 50 females in the group before the implementation of clinical pathway,and 51 males and 44 females in the group after the implementation of clinical pathway,The difference was of no statistical significance(?~2 = 0.004,P > 0.05).Five types were compared respectively,and there was no statistical significance in the difference(P > 0.05).(2)Age: Age distribution ranged from 3-76 years in the group before the implementation of the clinical pathway,with a median of 13(8,24)years.The age distribution ranged from 5-76 years in the group after the implementation of the clinical pathway and the median was 11(8.22)years.There was no statistical significance in the difference(Z =-0.349,P > 0.05).Five types were compared respectively,and there was no statistical significance in the difference(P > 0.05).2.2.Days of Hospitalization: The mean length of hospital stay was 11.75 days in the group before the implementation of the clinical pathway.The average length of hospital stay was 11.44 days in the group after the implementation of the clinical pathway.There was no statistical significance in the difference by rank sum test(Z =-0.247,P > 0.05).Five types were compared respectively,and the difference was of no statistical significance(P > 0.05).Except for the kidney type and mixed type,the simple type,joint type and the abdominal type were taken as research objects.The mean length of hospital stay was 9.82 days in the group before the implementation of the clinical pathway,and the average length of hospital stay was 9.57 days in the group after the clinical pathway,with no statistical significance in the difference(Z =-0.688,P > 0.05).3.Total Cost of Hospitalization: The average cost of hospitalization was 5587.17 yuan in the group before the implementation of the clinical pathway,and the average total cost of hospitalization was 5033.00 yuan in the group after the implementation of the clinical pathway.The total hospitalization cost in the group after the implementation of the clinical pathway was lower than that in the group before the implementation of the clinical pathway,but there was no statistical significance in the difference(Z =-1.704,P > 0.05).Five types were compared respectively,and there was no statistical significance in the difference(P > 0.05).Except for the kidney type and mixed type,the simple type,joint type and abdominal type were taken as research objects.The average cost of hospitalization was 4518.65 yuan in the group before the implementation of clinical pathway.The average cost of hospitalization was 4273.71 yuan in the group after the clinical pathway.The difference was of no statistical significance(Z =-0.666,P > 0.05).4.The Drug Costs and Proportion of Drug Costs:(1)Drug Costs: The average drug costs was 2743.35 yuan in the group before the implementation of clinical pathway,and the average drug costs was 1924.36 yuan in the group after the implementation of clinical pathway.The drug costs in the group after the implementation of clinical pathway was lower than that in the group before the implementation of clinical pathway,and the difference was of statistical significance(Z =-3.896,P <0.001).Five types were compared respectively,and there was no statistical significance in difference in terms of simple type(t=-0.060,P>0.05)and abdominal type(Z=-1.747,P>0.05).The drug costs in the group after the implementation of the clinical pathway was lower than that in the group before the implementation of the clinical pathway in the joint type(t = 2.210,P <0.05),kidney type(t = 2.965,P <0.05),and mixed type(Z=-3.210,P<0.05).There was statistical significance in the difference.(2)The Proportion of Drug Costs: The average proportion of drug costs was(0.47± 0.12)in the group before the implementation of the clinical pathway,and the average proportion of drug costs was(0.36 ± 0.11)in the group after the implementation of the clinical pathway.The proportion of drug costs in the group after the implementation of the clinical pathway was less than that in the group before the implementation of the clinical pathway,and there was statistical significance in the difference(t = 6.370,P<0.001).Five types were compared respectively,and there was no statistical significance in the difference of the simple type(t=0.931,P>0.05).The proportion of drug costs in the group after the implementation of the clinical pathway was lower than that in the group before the implementation of the clinical pathway in the joint type(t = 2.360,P<0.05),joint type(t=2.535,P<0.05),kidney type(t = 2.908,P<0.05),and mixed type(t=5.182,P<0.001).There was statistical significance in the difference.5.The Regression Days of Rash: The average regression days of rash was 8.76 days in the group before the implementation of the clinical pathway,and the average regression days of rash was 7.67 days in the group after the implementation of the clinical pathway.The days of the group after the implementation of the clinical pathway was less than that of the group before the implementation of the clinical pathway,but there was no statistical significance in the difference(Z =-1.889,P> 0.05).Five types were compared respectively,there was no statistical significance in the difference of the simple type(Z=-0.095,P>0.05),abdominal type(Z=-0.108,P>0.05),joint type(Z=-1.638,P>0.05),and mixed type(Z=-0.326,P>0.05).The regression days of rash in kidney type of the group after the implementation of the clinical pathway was less than that of the group before the implementation of the clinical pathway,and there was statistical significance in difference.6.Antibiotics Utilization Rate: The antibiotic utilization rate in the group before the implementation of the clinical pathway was 82.57%,and the antibiotic utilization rate was 70.53% in the group after the implementation of the clinical pathway.The rate in the group after the implementation of the clinical pathway was lower than that in the group before the implementation of the clinical pathway,and there was statistical significance in the difference(?~2 = 4.152,P<0.05).After comparing five types,the antibiotic utilization rate in the group after the implementation of the clinical pathway was lower than that in the group before the implementation of the clinical pathway,but there was no statistical significance in the difference(P> 0.05).7.The Antibiotic Days: The average antibiotic days was 9.07 days in the group before the implementation of clinical pathway,and the average antibiotic days was 8.37 days in the group after the implementation of clinical pathway.The antibiotic days in the group after the implementation of the clinical pathway was less than that in the group after the implementation of the clinical pathway,but there was no statistical significance in difference(Z =-1.592,P> 0.05).Five types were compared respectively,and there was no statistical significance in the difference(P> 0.05).8.Type of Antibiotic Use: The antibiotic use in the group before the implementation of the clinical pathway was mainly the first generation of cephalosporins,macrolides and lincosamides.The antibiotic use in the group after the implementation of the clinical pathway was mainly the first and second generation of cephalosporins.The difference between the two groups was that the use proportion of first-generation cephalosporins in the group before the implementation of the clinical pathway was higher than that in the group after the implementation of the clinical pathway,with statistical significance in the difference(?~2= 15.864,P <0.001),that the use proportion of second-generation of cephalosporins in the group after the implementation of the clinical pathway was higher than that in the group before the implementation of the clinical pathway,with statistical significance in the difference(?~2= 14.775,P <0.001),that the use proportion of lincosamides in the group before the implementation of the clinical pathway was higher than that in the group after the implementation of the clinical pathway,with statistical significance in the difference(?~2= 7.491,P<0.05),and that the use proportion of third-generation of cephalosporins in the group after the implementation of the clinical pathway was lower than that in the group before the implementation of the clinical pathway,with no statistical significance in the difference after chi-square test(?~2= 2.590,P>0.05).Five types were compared respectively,and the use proportion of first-generation of cephalosporins of abdominal and mixed type in the group before the implementation of the clinical pathway was higher than that in the group after the implementation of the clinical pathway,with statistical significance in the difference(P<0.05).The use proportion of third-generation of cephalosporins of mixed type in the group before the implementation of the clinical pathway was higher than that in the group after the implementation of the clinical pathway,with statistical significance in the difference(P<0.05).The use proportion of quinolone of mixed type in the group after the implementation of the clinical pathway was higher than that in the group before the implementation of the clinical pathway,with statistical significance in the difference(P<0.05).There were no statistics objections in the difference of the rest groups(P>0.05).9.Patient Satisfaction: The data of the return visit record in the group before the implementation of the clinical pathway was missing,and therefore only patient's satisfaction in the group after the implementation of the clinical pathway was summed up.The satisfaction rate of the return visit in the group after the implementation of the clinical pathway was 98.95%.Conclusion: 1.After the implementation of clinical pathway management in patients with Henoch-Schonlein Purpura in our hospital,the effect in drug costs,the proportion of drug costs,and antibiotic utilization rate has significantly declined compared with the previous condition,and the return patients have achieved higher satisfaction,which has effectively saved medical resources,reduced the patient's medical burden,and it also indicates that the clinical pathway management model has a good effect and value of application in the management of Henoch-Schonlein Purpura.2.After the implementation of clinical pathway in patients with Henoch-Schonlein Purpura in our hospital,the effect in the average length of stay,the total cost of hospitalization,the regression days of rash,antibiotic days and types was not obvious,which needs further study. |
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