Research On Utilization Of Clinical Pathways In Controlling The Medical Expenditure In A Hospital

ObjectiveClinical Pathway (CP) is an important measure to supervise the medical quality of single disease and to offer safe, effective, convenient, cheap health service. The objective of this study is to analyze the changes of medical expenditure component and to find out the key factors to the medical expenditure. Then the study offers practical methods to control the medical expenditure.Contents1.Account the expenditure of CP:Carry through study based on CP, analyze the component of the single diseases expenditure, account the expenditure of CP from the aspects of the hospital days,check-up item, medicine item, therapy item and operation item.2.Compare the component and difference of the expenditure: Compare the component and difference of the single diseases expenditure between before and after CP, analyze the key taches of CP, and find out the effective factors of single diseases expenditure after CP.3.Offer practical methods to control the medical expenditure: Evaluate the circs of carrying CP into execution, using the indexes of the hospital days, the medical expenditure and the component ratio of druggery fees. Find out the issues existing in the process of carrying CP into execution, and offer corresponding strategies to control the expenditure.Methods1. Materials: The study collects disease documents and medical expenditure lists of acute appendicitis operation, cesarean section, community acquired pneumonia in adults, pneumonia in children of a Grade 2A hospital in Shenzhen.2. Research Methods:â‘ Literature Method: Search for information about the domestic and foreign related literature by internet net work tools such as Pubmed, CNKI, Wanfang Data, Proquest Data and so on. â‘¡P anel Discussion: The study organized the experts in clinical, financial and disease document departments to discuss the standard and method to measure the expenditure of single diseases.â‘¢Health Economics Analysis: Compare the component and diversity of the expenditure between before and after CP.â‘£Health Statistical Analysis: Analyze the factors to the single disease expenditure between before and after CP by linear multiple regression.Results1. The diversity of cesarean section expenditure between before and after CP shows statistical significance.(Z=-3.60,P=0.01), the druggery fees increase after CP and the treatment fees decrease after CP, the whole expenditure decrease.2. The expenditure diversity of acute appendicitis operation, community acquired pneumonia in adults and pneumonia in children between before and after CP shows statistical significance(.P>0.05), the druggery fees increase (P<0.05) and the treatment fees decrease after CP(P<0.05).3. The hospital days are the primary factor to expenditure of four single diseases, and the expenditure of acute appendicitis operation and cesarean section have relation with method of the operation anaesthesia. The expenditure of community acquired pneumonia in adults has relation with patient age.Conclusion1. To design CP reasonably is an effective approach to control medical expenditure. The key factor to make CP reasonably is to shorten the hospital days and control druggery fees.2. The hospital should execute and spread CP strictly, constitute scientific and reasonable supervise system on CP, inspect the disease document termly and evaluate the effect of CP.3. Analyze the factors to the expenditure of single diseases based on the disease and demology character to find out the effective strategies on expenditure control and to make CP more scientific and perfect.