Effect Analysis On Arthroscopic Surgery Of The Knee By Clinical Pathway

Objective: To discuss the influencing factors of Clinical Pathway(CP) for arthroscopic surgery of the knee, and analyze the main factors that affect the period stayed at hospital and costs for medical service in order to estimate the effect of CP applying on patients treated by arthroscopic surgery in the knee and select optimal medical and management model for patients.Methods: Data of patients who were treated by arthroscopic surgery of the knee and whose primary diagnose of them was"knee osteoarthritis or obsoletemeniscus injury"were collected. The patients were grouped as the CP treating group who were in a third Grade first-class hospital of Shanxi Provice when CP technique was used from April 10th to October 30th and general treating group who were in same hospital from 2004 to 2006 when CP technique and arthroscopic surgery of the knee was not used. The CP's contribution to improve the social and economic benefits and management effectiveness and patients'satisfaction on arthroscopic surgery of the knee was studied. In order to reduce the variability of CP two standards were used: entering standard was in hospital and treated by single (double) side arthroscopic surgery of the knee; excluding standard: 1) there was focal infection in position near to knee; 2) knee ligament injury or fractures and need to be done internal and external fixation. Besides, data of other diseases which were treated by knee arthroscopic surgery and were not be managed by CP when CP technique was used in 2007 were collected to do satisfaction degree survey. All data were treated by statistical analysis: t-test, chi-square test, multiple regression analysis, and rank-sum test and so on employing the SPSS 13.0 Statistic software.Results: The average hospital days and cost are shortened, the medical service quality and patients'satisfaction degree are more obviously enhanced in CP treating group.1. The mean hospital days, the numbers of preoperative and postoperative hospital days are significantly decreased in the CP treating group than the general treating group, especially in the preoperative hospital days. The results show that the mean hospital days are significantly decreased 1.51 days (P<0.05), through the implementation of CP in patients with knee arthroscopic surgery compared with cases that were not treated by CP.2. Besides the expense used in Chinese medicine, anesthesia, pathology inspection, the expense of nursing and person-attendance, there were significant statistical difference in expense for other area between patients treated by CP or routine management. The total expense used in hospitalization, western medicine, beds, inspection, treatment charges, aspiratory oxygen etc. were significantly decreased in patients who were treated by CP. The results show that mean cost of the total expense be in hospital is decreased 1334.77 Yuan (P<0.05), especially western medicine, which decreased 926.29 Yuan averagely (P<0.05).3. All patients who treated by CP and routine management were cured or improved, and there was no significant difference between them, nosocomianl infections were also not found. The results show that cure rate of patients was 91.95% in the patients treated by, which is significantly higher than that of patients treated by routine management (79.80%) (P<0.05).4. The satisfaction degree level was higher significantly in the patients treated by CP as compared with patients treated by routine management. The satisfaction degree scores in treating service, nursing service, service offered from auxiliary departments, medical expenses and the treatment results, information consent were significantly higher in the patients treated by CP as compared with the patients treated by routine management. No signification difference of satisfaction degree score was shown in other service: the admission process and medical facilities.Conclusions: The CP can standardize actions of medical care and decrease the waste of resources. The CP not only decreases effectively the average number of days and hospital costs, but also to some extent improves the patient's right to know and care satisfaction levels without affecting the therapeutic efficacy at the same time, so as to bring a better social and economic benefit for hospital.