| A pilot project of the clinical pathway is recently launched in some areas. It is attached great importance by the health administration department in different levels and medical institutions. It is a common view for medical supervisors to improve medical efficiency, medicine quality and control unreasonable medical expense. It can be used to build an evaluation model the effect of clinical pathway for Hospital Z in order to promote Hospital Z to monitor the process of implementing the clinical pathway, and to find problems timely, and to improve measures and supply suggestion. It can be also applied to supply fundamental research data for helping the health administration department analyze and evaluate systematically and comprehensively the working effect of the pilot project of clinical pathway.Objectives1. This research was to observe whether clinical diagnosis and treatment were normative, whether the medical efficiency, therapeutic effect, medical expense and other factors were improved, and the use of antibacterial was reasonable from an analysis on the implementation effect of the clinical path.2. It can be used to supply the fundamental research data for exploring, building and improving clinical management system, work pattern, operational mechanism, quality evaluation and continual improvement system which were appropriate for the actual situation of Hospital Z.3. It can be used to supply the fundamental research data for a comprehensive implementation of the system of paying the expense for a single disease for the medical insurance list of Hospital Z.4. It can be used to supply the fundamental research data for helping the health administration department supply analysis, evaluate the implementation of clinical path, establish and improve the policy system of clinical path.Methods1. The statistical software SPSS10.0was mainly used, and excel were also applied. The data after implementing the clinical path in2011and the baseline data in2007,2008and2009were compared to analyze the change of the individual observation factors after one-year performance of clinical path.2. Data collection, index measure and calculate were based on the implementation requirement of clinical path of the Ministry of Health. Statistical methods, including analysis of variance, chi-square test (X2test), non-parametric test (significant level=0.05), were used to analyze the effect of15departments and38diseases after the implementation of clinical path.3. Diseases, including diabetes II, trigeminal neuralgia, esophageal cancer, were selected among the illnesses of internal medicine, surgical department and TCM department and mainly analyzed by SPSS10.0in order to observe the change of individual factors.Results As for the efficiency, the overall hospital day (HOD) decreased by1.9days after carrying out the clinical pathway. HOD of internal department decreased2.6days, and that of surgical department decreased by1.6days, and that of TCM department decreased by8.7days. For the single disease, diabetes Ⅱ decreased by2.4days, trigeminal neuralgia increased by1day, esophageal cancer didn’t change significantly. The overall preoperative HOD decreased by1.8days, and the preoperative HOD of trigeminal neuralgia decreased by0.7day. As to the effect, the overall recovery rate increased by7.3%compared to that in2007, and increased by7.2%compared to that in2008. The recovery rate of diabetes Ⅱ increased by4.1%compared to that in2007, and increased by4.4%compared to that in2008. The recovery rate of trigeminal rate increased8.9%. The overall improvement rate increased by2.3%, and that of diabetes Ⅱ decreased by3.8%, and of trigeminal neuralgia decreased by8.4%. The overall death rate decreased by0.2%, and that of diabetes Ⅱ didn’t change significantly, and of trigeminal neuralgia decreased by0.5%. The overall re-hospitalization rate decreased by20%, and that of diabetes Ⅱ decreased by32.3%, and of trigeminal neuralgia and esophageal cancer didn’t change significantly.With respect to the medical expense, the average hospital expenses decreased by6129RMB, and diabetes Ⅱ deceased3234RMB, trigeminal neuralgia5381RMB, esophageal cancer27839RMB, but it was not significant in statistical analysis. The average medicine fee decreased2892RMB, and of diabetes Ⅱ decreased1363RMB, of trigeminal neuralgia1381RMB, of esophageal cancer12335RMB, but it was not significant in statistical analysis. The average cost of supplies decreased1022RMB, and of diabetes Ⅱ didn’t change significantly, of trigeminal neuralgia decreased1231RMB, of esophageal cancer decreased8015RMB, but it was not significant in statistical analysis. The inspection charge reduced by507RMB, and of diabetes Ⅱ1258RMB, trigeminal neuralgia908RMB, esophageal cancer2350, but it was not significant in statistical analysis. The average cost of most of the single illness fell down, but it is not meaningful in statistical analysis. The average cost of33illnesses decreased, of diabetes Ⅱ decreased by28.2%, of trigeminal neuralgia decreased by19.1%, of esophageal cancer (TCM) decreased by71.5%. The daily expense of most of the illnesses fell down, but it is not meaningful in statistical analysis. The daily expense of28illnesses decreased, of diabetes Ⅱ decreased by13.7%, trigeminal neuralgia26.3%, of esophageal cancer (TCM)51.0%.In regard to the use of antibiotics, antibacterial drug use day increased step by step, but that of diabetes Ⅱ didn’t change significantly, and even of trigeminal neuralgia decreased step by step. The average cost of antibacterial drug increased stop by step by step, but of diabetes Ⅱ didn’t change significantly, and of trigeminal neuralgia de creased step by step. The third-line antibacterial drugs use percentage changed insignificantly. They were not used for diabetes Ⅱ patients. It didn’t show significant change in trigeminal neuralgia patients. For the condition of variation, the overall variation was controlled well. The following reasons for variation were:department, medical staff, the patient himself, insufficient cooperation among departments, elaboration of the clinical path, and other reasons.Conclusions As for the efficiency, the hospital day (HOD) and preoperative hospitalization day decreased significantly. HOD in internal department, surgical department and TCM decreased in different degrees, only HOD of several diseases increased slightly. Therefore, the application of clinical pathway decreased HOD and preoperative hospitalization day and improved the medical efficiency to some extent.As to the effect, recovery rate, improvement rate, death rate, re-hospitalization rate improved in different degrees, only the improvement rate of several diseases declined. Therefore, the implementation of clinical pathway improved recovery rate, improvement rate, decreased death rate and re-hospitalization rate and improved the medical quality to a certain degree. With respect to the medical expense, hospital expenses, medicine fee, the cost of supplies and inspection charge reduced significantly. The average cost and daily expense of most of the illnesses fell down, only of single illness changed insignificantly. As a result, the application of clinical pathway decreased the medical expense, hospital expenses, medicine fee, the cost of supplies and inspection charge. It controlled the unreasonable medical expense to some extent.In regard to the use of antibiotics, antibacterial drug use day, average cost, the third-line antibacterial drugs use percentage changed insignificantly. However, the former two factors of trigeminal neuralgia patients decreased significantly. So the implementation of clinical pathway didn’t constrain the use of antibiotics.For the condition of variation, the overall variation was controlled well.The pilot project of the clinical pathway of Hopital Z was relatively successful. |
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