The Construction And Evaluation Of Optimized Management Of Integrated Chinese And Western Medicine For Patients With Panhysterectomy

Object ivesHow to make the patient enjoys the superior quality of the medical treatment nursing service by the cheap expenses, satisfy "take patient as the center" of request and high quantity serve efficiently, have become an important topic of the health profession.The governor must consider how to let the patient reasonable to use "the medical treatment expenses" with maximum limit throught the medical treatment service process. Aim at the some disease grows to adopt with surgical operation, the clinical pathway is a valid path to get the purposes of improving the serve for patient and making use of the health resources effectively. Clinical pathways(CP) is a standardization method of diagnose and treat, and its main charceteristics is to shorten average hospitalization days and pay medical cost reasonably, to design the most reasonale medical and nurse scheme by entity, to arrange the hospitalization days and medical cost reasonably and to improve medical service quality. Every country has pay attention to the use of CP, and CP has become a new medical mode in new century.The patients of the panhysterectomy, with long and complex course, often has longer inpatient days, higher hospital expense. Shaping the clinical pathway, to standard hospital management process, short inpatient days, reduce hospitalization fees, has become a top priority.It has a great significance to educe dominance of western medicine and Chinese medicine by constructing panhysterectomy clinical pathways of integrated traditional Chinese and western medicine, to explore the construction method of panhysterectomy inhospital of traditional Chinese medicine, to improve the therapy level of integrated traditional Chinese and western medicine, methods of health supervision, quality and level of medical service.Research purposes1. According to the scientific principle of clinical pathway consruction, we optimized the TCM diagnosis scheme of panhysterectomy, and initially formed a TCM therapy with high degree of consensus, sufficient evidence, and powerful generalization, for providing the core content of clinical pathway.2. With preliminary clinical observation of panhysterectomy pathway, we preliminary discuss clinical effect of panhysterectomy clinical pathway of nondialytic period, Which provide a basis for the form to the A panhysterectomy clinical pathway with integrated Chinese and Western Medicine.Research contentThis research is divided into two parts. The first part of the research focuses optimization of panhysterectomy nondialytic treatment scheme of TCM. The second part of the research is to carry on the preliminary clinical observation of panhysterectomy combine traditional Chinese and western medicine clinical pathway.1. Constructing optinal research of clinical pathwayWith regard to the retrospective study results, we determine the management time of clinical pathway, and formulate inclusion and exclusion criteria, and then design implamentation flow path. According to the clinical pathway issued by health ministry 2009, we formulate clinical pathway of panhysterectomy of nondialytic period.2. Clinical observation research of clinical pathwayWe collect six hospitals about 450 patients with panhysterectomy of clinical pathway from December of 2009 to October in 2010, which content 376 cases of TAH,27 cases of TVA,42 cases of LH, withdrow 5cases. Also we included 544 cases records with path into standard from the serial of January 2007 to December 2008 in the hospitals, which content 487 cases of TAH,9 cases of TVA and 48 cases of LH. and analysis the record number, hospitalization costand improved hospital lab index before hospitalization and after. Through the comparison, we discussed the clinical benefits of clinical pathway.The efficacy of the optimized management of Integrated Chinese and Western Medicine for patients with panhysterectomy was evaluated by retrospective and prospective controllled study according to clinical epidemiology or DME approach.Research results1.The research of expert consultationThe results showed that the respond rates of the two expert consul tation was both 100%. After the two-round meetings, one second-class indicators was modified and 15 items were revised. At last, the 28-items were developed which covers 3-first-class indicators and 8-second-class indicators.2. Assessment on Clinical Pathway of the panhysterectomy2.1 The effect of CP on length of stay in different surgery type:(1) TAHThere was statistically significant difference between retrospective group and CP group in the average hospitals day(11.77±3.79days vs.10.57±2.05days,P<0.05).(2) TVAThe comparison between retrospective group and CP group in the average hospitals day showed statistically significant difference (9.5±3.89days vs.8.81±2.06days, P<0.05).(3) LHThe comparison between retrospective group and CP group in the average hospitals day showed statistically significant difference (10.77±2.31days vs.9.33±1.97days, P<0.05). there was statistical difference in total length of stay between CP group and retrospective group (P<0.05) in the different suegical type. It mean that CP could reduce length of day.2.2 The effect of CP on hospitalization expenses(1) TAHThe average total expenses:The comparison between retrospective group and CP group in average total expenses showed statistically significant difference(9385.50±2047.67Yuan vs.9024.41±2902.47 Yuan, P<0.05); medicine expenses:There was statistically significant difference between two groups (1225.17±837.47Yuan vs.1310.46±674.98 Yuan, P<0.05);check fee:The comparison between retrospective group and CP group in check fee showed statistically significant difference(413.70±358.09Yuan vs.316.04±235.47 Yuan, P<0.05);cure expenses:There was statistically significant difference between two groups in cure expenses (1735.28±920.34Yuan vs.1221.48±606.62 Yuan, P<0.05).(2) TVAThe average total expenses:The comparison between retrospective group and CP group in average total expenses showed statistically significant difference(7728.16±1934.25Yuan vs.9111.9674±2533.95 Yuan, P<0.05); medicine expenses:There was statistically significant difference between two groups (1254.81±306.73Yuan vs.1172.50±375.25Yuan(P<0.05);check fee:The comparison between retrospective group and CP group in check fee showed statistically significant difference (359.06±299.18Yuan vs.315.11±303.82Yuan, P<0.05); cure expenses:There was statistically significant difference between two groups in cure expenses (1214.06±769.44Yuan vs.1002.59±593.47Yuan, P<0.05).(3-) LHThe average total expenses:The comparison between retrospective group and CP group in average total expenses showed statistically significant difference (9154.05±1749.86Yuan vs.12497.68±3238.05 Yuan, P<0.05); medicine expenses:There was no statistically significant difference between two groups (1049.86±604.27Yuan vs.1703.48±670.85 Yuan, P>0.05);check fee:The comparison between retrospective group and CP group in check fee showed statistically significant difference(403.43±304.89Yuan vs.358.23±189.83Yuan, P<0.05); cure expenses:There was no statistically significant difference between two groups in cure expenses (1548.89±595.58Yuan vs.1807.49±1280.92Yuan, P>0.05)2.3 The effect of CP on recovery of gastrointestinal function:(1) TAHFirst bad time:The comparison between retrospective group and CP group in First bad time showed statistically significant difference(46.21±11.35hour vs.33.56±9.58 hour, P<0.05); first exhaust time: There was statistically significant difference between two groups in first exhaust time (51.62±12.33hour vs.43.71±13.58hour, P<0.05); first defecate time:There was statistically significant difference between two groups in first defecate time (90.70±22.89hour vs.77.25±24.02hour, P<0.05).(2) TVAFirst bad time:The comparison between retrospective group and CP group in First bad time showed statistically significant difference (31.29±7.53hour vs.26.53±7.14hour, P<0.05); first exhaust time:There was statistically significant difference between two groups in first exhaust time (42.58±11.93hour vs.35.37±12.31hour, P<0.05); first defecate time:There was statistically significant difference between two groups in first defecate time (88.26±25.76hour vs.74.59±19.79hour, P<0.05).(3) LHFirst bad time:The comparison between retrospective group and CP group in First bad time showed statistically significant difference (32.14±9.56hour vs.28.45±8.43hour, P<0.05); first exhaust time:There was statistically significant difference between two groups in first exhaust time (49.41±12.78hour vs.36.42±13.71hour, P<0.05); first defecate time:There was statistically significant difference between two groups in first defecate time (84.91±18.31hour vs.69.38±24.13hour, P<0.05).2.4 The effect of CP on postoperative complications:There was statistieal difference between two groups in complitions (P<0.05)2.5 the result of satisfaction survey:The patients are satisfy at every item, the total satisfaction reach to 97.55%.2.6 The result of CP on variance:In 450 cases, Through the statistical analysis of the variances, it was found that the incidence of variance categories in present research which ranged from high to low practitioners 27.1%(122/450)>hospital system22.2%(100/450)>patients' requirements20%(90/450)>disease progress 10.2%(46/450)>and withd rawcases1%(5/450). The incidence of the controllable variances were higher incidence of the controllable variances were higher (25.50%(38/149)) than the uneontrollable, according to the manage ability of variance62.01%(142/229).Conclusion1. The core of the clinical pathway is the treatment scheme which has the characteristics of intergrated Chinese and Western Medicine.The research through expert consultation which based on literature research and clinical experience of department preliminary made of therapy, which include implement of CP,the evalution of effection,the evalution of efficiency and the part of perioperative medical treatment. We preliminary determine the surgical selection criteria,the time of using antibiatics,Chinese medicine treatment after surgery,efficacy and efficiency evaluation.2. With regard to the retrospective study, we determine target population and the exit criteria of path, total path time limit, implement processes of path on the basis of optimized seheme. Also we form path form, according to pathform format issued by the state ministry.3. The clinical pathway regulates the management of our hospital process, reduces hospital expenses (main reduce the expenses of TAH);shortens hospitalization days, improves patient clinical symptoms; ensure the quality of medical treatment. Explanation of clinical pathway standardized management and strengthen the characteristies of the application.