Study On Clinical Pathway Management Based On PDCA Circulation

Objective:This study intends to promote the practice of clinical pathway management by using PDCA cycle method in a tertiary general hospital.From the macro level of the hospital and the micro level of disease types,combined with qualitative and quantitative research,this study systematically and comprehensively evaluates the effect of PDCA on the operation index and quality index of clinical pathway,so as to provide case reference for promoting the application of clinical pathway management tools.Methods:Through literature review,to understand the current situation of clinical pathway at home and abroad.Combined with expert consultation,on-the-spot interviews with key figures,on-the-spot investigation and other forms,to understand the process of using PDCA cycle to promote clinical pathway in sample hospitals,select evaluation indicators;use the information system to extract the clinical pathway management data of sample hospitals from 2016 to 2019.Statistical analysis of PDCA cycle before and after the application of the number of clinical pathway diseases,coverage,access rate,completion rate and variation rate of the operation index changes.To explore the effect of PDCA cycle on the operation of clinical pathway from the macro level.According to the inclusion and exclusion criteria,483 patients with acute cerebral infarction before and after the implementation of PDCA were selected and divided into three groups: Group 1 was not included in the clinical pathway group before PDCA.Group2 was the traditional clinical pathway group before PDCA.Group 3 was the clinical pathway group after PDCA optimization.The average length of stay,average hospitalization expenses and cost structure,patient outcomes,and the time from emergency treatment to hospitalization were compared among the three groups,and the influence of PDCA cycle on the quality and effect of clinical pathway was discussed from the micro level.Data processing used the SPSS17.0 and Excel.Measurement data alone groups were compared using independent samples t test between group compared using LSD test.X2 test was used to compare the count data.SKN test was used to compare the count data between the two groups.To P<0.05 for the difference was statistically significant.Results:1.Operation effect:The number of diseases included in clinical pathway management in the whole hospital increased from 86 in 2016 to 770 in 2019,with significant effect.The coverage rate increased from 30.10% in 2016 to 89.42% in 2019,with significant improvement effect.The runoff rate increased significantly from 75.01% in 2016 to 99.84% in 2019.The completion rate is from 96.01% in 2016 to 96.02% in 2019,which has been running well and at a high level,but the promotion effect of PDCA is not obvious.The variation rate increased from 17.36% in 2016 to 49.79% in 2017,and then decreased to 11.26%,showing a state of first rising and then declining,which belongs to the joint and several reaction of increasing coverage rate.Through PDCA cycle key management,the decline effect is obvious.2.Quality effect Taking acute cerebral infarction as an example,compared with the other two groups,the average length of hospital stay after PDCA optimization was the shortest,which was11.76 days(P < 0.05).The average total cost of hospitalization was 11042.2 yuan,which was lower than the other two groups(P < 0.05).In the cost structure,the proportion of diagnosis fee and medicine fee was the lowest(P < 0.05),and the comprehensive medical service fee and treatment fee reflecting the labor value of medical staff was the highest(P< 0.05),which was in line with the national policy requirements and the direction of medical reform.The consumables cost did not decrease significantly(P > 0.05).Due to the sample selection reasons are basic consumables,no high-value consumables,need to improve the sample for further research in the future.The improvement rate of PDCA optimized clinical pathway group was the highest(P < 0.05).Optimization project of PDCA:Group 3 had the highest proportion of less than 60 minutes from emergency treatment to admission(P < 0.05).PDCA optimizes the diagnosis and treatment process and effectively shortens the time from emergency treatment to admission.Conclusion:Through PDCA cycle to optimize the management of clinical pathway,the operation effect of clinical pathway is improved,and the quality of clinical pathway is promoted.It shows that the application of PDCA cycle in clinical pathway is helpful to the continuous improvement of the quality of clinical pathway.PDCA is an effective clinical path management mode,which is of great significance to keep the scientific and reasonable development of clinical path management in hospitals.