Construction And Application Of Evaluation Index System For Standardized Implementation Of Clinical Pathway In The County Hospital

ObjectiveTo construct a set of evaluation index system applicable to the standardized implementation of clinical pathway in county-level public general hospitals,promote the continuous standardization and optimization of hospital clinical pathway management,and provide reference for the standardized implementation of clinical pathway.MethodsOn the basis of literature review and policy analysis,this study combines theoretical research,focus group discussions,field investigations,interviews,etc.,and takes PDCA quality management theory as the theoretical basis,from "Plan-Do-Check-Action" four dimensions to establish a standardized framework for the implementation of the clinical path evaluation index system,apply Delphi method for two rounds of expert consultation,and use the analytic hierarchy process(AHP)to calculate the index weight coefficients in 4 counties Level public general hospitals carry out empirical applications.Epidata 3.1 was used to establish a database and perform data entry.SPSS 21.0 and yaahp 11.0 were used for statistical analysis.Results1.Delphi expert consultation results show that the authority coefficient of 28 experts from universities,health administrative dqpartments and medical and health institutions to the first level indicators is between 0.829 and 0.875,the Kendall harmony coefficient(W)of the first round of first level indicators is 0.481 and 0.452 respectively,the importance and feasibility of the second round of first level indicators are 0.685 and 0.543 respectively,P values are less than 0.05 The results were statistically significant.2.The preliminary framework of standardized implementation of clinical pathway evaluation index system consists of 4 first level indexes,13 second level indexes and 54 third level indexes.After two rounds of expert consultation,the final index system includes four first level indexes,12 second level indexes and 45 third level indexes.3.Using analytic hierarchy process to calculate the weights of all levels of indicators,the composite weight coefficients of the first level indicators are:organization and planning(0.1836),implementation and control(0.2867),inspection and evaluation(0.4325),feedback and adjustment(0.0972).The combination weight coefficient of the second level index is 0.0162-0.2695,and that of the third level index is 0.0022-0.0917.4.The results of field application of the evaluation index system in four county hospitals in Anhui and Fujian Province showed that the comprehensive scores were:A1(78.70 points),A2(80.37 points),B1(86.52 points),B2(84.24 points).Generally speaking,the defect rate of doctor-patient education,information system,examination and evaluation,variation management,path adjustment and report feedback is higher.Conclusions1.A set of evaluation index system suitable for the standardized implementation of clinical pathway in county-level public general hospitals in China has been established.The index setting is reasonable.The consultation experts have good representativeness,high degree of enthusiasm,authority and coordination.And the research process is rigorous and complete.2.In the empirical application of the index system in county-level hospitals,the data collection is feasible,and the calculation method is scientific.It can find out the deep-seated problems in the clinical pathway management work,which is helpful to improve the standardization degree of the implementation of the clinical pathway in hospitals,and has reference value and significance for standardizing the current clinical pathway management work in county-level hospitals in China.3.Medical institutions should focus on strengthening doctor-patient education,improving information system,perfecting inspection and evaluation,attaching importance to mutation management,and standardizing path adjustment,so as to improve the standard implementation degree of clinical pathway.