The Multiple Center Study Of Acute Ischemic Stroke Clinical Pathway

BackgroundCerebralvascular disease (CVD) has become the first cause of death and disability in both urban and rural areas. The patients suffered the cerebralvascular disease are increasing year by year. There are over7million patients of CVD in china, of which about70%are ischemic stroke. According to the experts, the amount of stroke patients will be twice as it was now until2020and the death rate is about30%-50%. Among the survivial patients, about3/4lost labour. Meanwhile, the recurrence rate of stroke is also high which is40%in5years. Nowadays, the direct cost of stroke is about10billion every year and the total cost is about20billion which is a great burden to the country. Clinical pathway, as a management pattern which can control both the time and cost, has been induced to the medical area. Based on the hypothesis that the clinical pathway of acute ischemic stroke can reduce the cost and hospitalization days on the condition of guaranteeing the effect, this study applied the historical control study to evaluate the effect of clinical pathway.Object i veBased on the protocol of acute ischemic stroke clinical pathway of our department through the literature research and experts consensus, applying the multiple center historical study to evaluate the clinical pathway of acute ischemic stroke.MethodMultiple center perspective study and retrospective study have been applied during2010.1-2010.10.The prespective study apply the acute ischemic stroke clinical pathway and the retrospective study as the control group. At last, evaluate the effect of clinical pathways through the comparation of perspective study and retrospective study.Results299patients are enrolled to the prospective study and728patients are enrolled to the retrospective study. The comparasion of the perspective study and the retrospective study showed that the application of acute ischemic stroke clinical pathways can elevate the effective rate and reduce the occurrence rate of complications (hernia, pneumonia and urinary tract infection). At the same time, it can reduce the cost and the hospitalization days.And the inner analysisi of the perspective study showed that swallowing level and the complications are related to the effect. Pneumonia and the progressive stroke is the most common complications and of which the swallow level and the yin-yang syndrome are the influencial factors of progressive storke. As to the cost and hospitalization days, the amount of the variations is the influential factors of the cost but not related to the hospitalization days.As to the degree of satisfaction,both the patients and the doctors feel good about the linical pathway and the total degeree of satisfaction is over90%.ConclusionThe application of clinical pathway can improve the effect of acute ischemic stroke, decrease the occurrence rate of some complications and reduce the cost and the hospitalization days.