A Research On The Application Of Clinical Pathways To Real-time Control Of Medical Quality

With our country's entry into WTO, increasing competition exists in our medical market, and hospitals face tremendous challenges. Only through improving medical quality, reducing medical cost and offering optimal service with the limited medical resources, can hospitals turn the challenges into opportunities for development.Real-time control of medical quality aims at enhancing process management of medical quality on the basis of hospital total quality management, making the monitoring and control of medical quality more effective and continuous by the building of hospital information systems, and achieving the purpose of 'high-quality, high-efficiency and low-cost' management. Clinical pathways can offer perfect conditions to real-time control of medical quality as a means to control quality through process standardization. Within the overall frame of real-time control of medical quality, this research designs effective, convenient, practicable ways of the standardization and management of the hospitalization diagnosis and treatment process by referring to advanced domestic and overseas management experiences such as clinical pathways and time management, and associating the reality of domestic hospital management, in order to realizereal-time control of the quality of hospitalization diagnosis and treatment, and to gain the aims of improving medical quality, reducing medical cost and increasing inpatient satisfaction level.Based on the idea of continuous quality improvement, the research focuses on 'the management process ensuring high-quality service process of hospitalization diagnosis and treatment' and 'the procedure and process of improving quality', establish the conception of real-time control of the quality of hospitalization diagnosis and treatment which consists of process improving, continuous improving and preventive improving. A model of clinical pathways in real-time control of the quality of hospitalization diagnosis and treatment has been set up.The research has designed some methods for clinical pathways. In selecting objects for exploitation, we suggest grouping disease entities by surgical operation techniques, comparing the coefficient variances of the average hospitalized days of each grouping, and then evaluating the ease or difficulty of standardization. In planning the standard hospitalized days of clinical pathways, we have refered to the theory and method of project time management of business administration in Europe. This method sets the optimal standard time by woke breakdown analyzing, and then find out the critical path of the process of hospitalization diagnosis and treatment. On the method of clinical pathways management, we suggest establishing the organization system and criterion of clinical pathways management on thebasis of hospital existing management institution. On the method of variance management, we suggest using the proportion of controllable variance to evaluate the rationality of clinical pathways, and regarding the variances that delay hospitalized days or the controllable variances that happen frequently as the management emphases.The research used clinical pathways in real-time control of medical quality for the first time and has gained remarkable effect. Particularly. With inpatients of osteoarthritis of knee joint, obsolete meniscus injury and tears wound of meniscus, those who were on clinical pathways had a low average length of stay by 3.17 days (9.85 vs. 6.68 days), a low average total charge by 1,191 Yuan (4,490 vs. 5,681 Yuan) and a high satisfaction level, in comparison to the control patients.