A Comparative Study On The Effect Of Clinical Pathway On Hospitalization Expenditure And Length Of Stay Among Patients With Senile Cataract Surgery

Background:The difficulty and high cost of treatment caused by the unreasonable allocationof medical resources and the rapid rise of the medical costs are the focus of the society as well as the point of the medical-sanitary system reform.The clinical pathway,which formed under the background of the rapid rise of medical expenses in the United States in the early 1970s,has shown its superiority in controlling medical expenses and shortening the average length of stay.In China,after medical-sanitary system reform has entered the deep water period,the clinical pathway has gradually become an important form of management to control medical costs,improve medical efficiency and standardize the diagnosis and treatment behavior.Cataract is the leading cause of blindness in the world.Every year,there are more than 2.5 million people suffer from cataract blindness in our country,including the senile cataract,which is the main type.Until now,there is no effective drugs for the prevention and treatment of cataract,surgery is still the only effective method for cataract.Phacoemulsification combined with intraocular lens implantation(IOL)(13.41+13.71)is the most common surgical approach.Senile cataract(H25.901),as a common disease and single disease payment disease,its treatment process is relatively fixed,the patients are less affected by the variation factors,which is suitable for as clinical pathway.A three level of first-class hospital in Anhui province in this study has carried out the comprehensive clinical pathway management of senile cataract since January 1,2016.Objective:1.On the basis of clinical pathway imformatization,the design of clinical pathway forms for the diagnosis of senile cataract phacoemulsification cataract extraction combined with intraocular lens implantation is completed by the multi-sectoral collaboration;2.By comparing the changes before and after the implementation of clinic al pathway management of ophthalmology in a three level of first-class hospita 1 in Anhui province,including the changes of other indicators of hospitalized senile cataract surgery combined with intraocular lens implantation for cataract phacoemulsification during the period of hospitalization expenses,we discuss the effects of the implementation of clinical pathway in shortening hospitalization days,controlling the medical expenses.Methods:In this study,we choose a three level of first-class hospital of Ophthalmology in Anhui as a research institute,which provides adequate cases for this study.In this study,patients included in the standard:phacoemulsification and intraocular lens implantation for senile cataract cases from April 2015 to September 2016.From January 1,2016,the hospital has carried out the implementation of clinical pathway management of senile cataract,while senile cataract patients were not in clinical pathway management from April to December 2015,from January to September 2016,senile cataract patients were managed according to clinical pathway.We discuss the effects of clinical pathways on the indicators of senile cataract by analyzing the average hospitalization expenditure,average drug expenditure,average materials expenditure,average surgery expenditure,average examination expenditure average length of stay,the proportion of a variety of expenditure before and after the implementation of clinical pathways.Related data are derived from the hospital of HIS(Hospital Information System)system and clinical pathway software;Cases of screening is carried out by using the electronic medical record system and other auxiliary;Using Excel 2007 to establish database;SPSS 19.0 statistical software is used to process and analyze the data obtained from the study,?2±s is for the measurement data,statistical method to describe the rate is for the count data.The t test and chi square test are used for statistical analysis,the difference was statistically significant with P<0.05.Results:A total of 1294 cases were selected according to the inclusion criteria and exclusion criteria,including the control group(n=651)and the path group(n=643).Compared with the control group,the average hospitalization expenses of the path group,decreased 200.48 yuan(t=3.783,P=0.000);the average hospitalization days decreased 0.63 days(t=5.516,P=0.031);the average drug expenditu re decreased by 75.5 yuan(t=4.694 P=0.000);the average examination expenditure decreased by 96.89 yuan(t=6.772,P=0.008);the average surgery expenditure decreased 63.52 yuan(t=4.108,P=0.000),all the differences were statistically significant.As for the expenditure ratio,the average drug expenditure of the path group accounted for 7.47%,while 8.28% of the control group(P<0.05);The proportion of inspection charge in the path group decreased by 1.31%(P<0.05)compared with the control group,the difference was statistically significant.The average material expenditure of the path group accounted for 18.61%,while the control group was 18.93%(P>0.05).Compared with the control group,the path group was 0.09%lower(P>0.05),the difference was not statistically significant.Path group compared with control group,the average bed day costsinc reased by 110.66 yuan(t=6.214,P<0.05),the difference was statistically signifi cant.Conclusions:1.After the implementation of clinical pathway management,the average hospitalization expenses,average drug cost,average examination cost,average cost of surgery of senile cataract phacoemulsification cataract surgery combined with intraocular lens implantation patients were significantly decreased.2.After the implementation of clinical pathway,the average hospitalization days of the senile cataract phacoemulsification cataract surgery combined with intraocular lens implantation patients decreased by 0.63 days,which effectively improved the bed rotation rate,and the efficiency of the medical treatment.