The Retrospective Study Of Clinical Pathway For Acute Myocardial Infarction Of Of Integrated Traditional And Western Medicine

PurposeThis study was carried out evaluation of Traditional Chinese and Western Medicine of acute myocardial infarction clinical pathway in Guangdong Provincial Hospital of Traditional Chinese Medicine,for the effectiveness and health economics assessment of acute myocardial infarction Traditional Chinese and Western Medicine clinical pathways,and for the reference of forward-looking acute myocardial infarction Traditional Chinese and Western Medicine of the Clinical Pathway programs.MethodsThrough the same period in the history of non-controlled case study approach, the study select the patients whom the first diagnosed as "acute myocardial infarction" be in hospitalized in ICU or Heart Center of Guangdong Provincial Hospital of TCM from January 2003 to December 2004 as non-clinical pathway group,and the patients whom the first diagnosed as "acute myocardial infarction" be in hospitalized in ICU or Heart Center of Guangdong Provincial Hospital TCM from January 2006 to December 2007 as clinical pathway group,compared with two groups of hospitalized patients with major relevant circumstances.The main evaluation indicators:such as length of stay, hospital costs,hospital incidence of major cardiovascular events, re-admission in 1 year,incidence of major cardiovascular events in 1 year,and so on.ResultThe study collects 141 cases in line with the inclusion criteria,including The clinical pathway group of 71 cases,and the non-clinical group of 70 cases, two groups of hospitalized patients with no significant difference in the situation.The total length of stay from 12.01±7.349 days down to 9.80±5.618 days(P=0.047),ICU length of stay from 7.33±6.467 days down to 5.55±2.932 days(P=0.038).The total stay length of the patients who accepted interventional therapy from 13.34±7.490 days down to 9.69±5.593 days(P=0.005),the ICU stay length from 8.66±6.672 days down to 6.02±3.617 days(P=0.014).The interventional treatment rate from 71.43%up to 85.92%, the coronary stenting treatment rate from 50%up to 76.06%.The total hospitalization cost of thepatients accepted coronary stenting decreased from 65,059.25 yuan to 53,477.53 yuan.there was a upward trend of the total hospitalization cost of all patients were rised from 45,644.24 yuan to 49,472.81 yuan(P=0.183).The usage of proprietary Chinese medicines which quicken the blood and supplementting the heart qi,especially represented by Tongguan capsule,has rised from 58.57%up to 83.09%.The usage of intravenous Chinese medicine which quicken the blood and transform stasis has rised from 64.29%up to 81.69%.The utilization of traditional Chinese medicine decoction which supplementting the heart qi and quicken the blood and transform stasis has rised from 61.43%up to 84.51%.In the curative efficiency of Chinese medicine,there were significant improvement between the two groups in the total score and these aspects,for example,chest distress,cardiodynia,fatigue,restlessness and dizziness.There was a downward trend of Hospital mortality rate declining from 14.29%to 7.04%(P=0.183),the mortality rate decreased by 7.25%.re-admission and discharged during 1 year decreased from 24 times to 14 times(P＜0.05),MACE occurred during 1 year decreased from 19 times to 10 times(P＜0.05).ConclusionThe implementation of clinical pathways in acute myocardial infarction can reduce the total length and ICU length of stay,reduce the total cost of the patients accepted coronary stenting,decreased the re-admission and MACE events in 1 year,improve the prognosis of patients,intervention in the treatment of patients with lower total cost of hospitalization,patients discharged from 1 year to reduce re-admission and the incidence of MACE and improve the Chinese medicine symptoms and prognosis of patients.For the next step on the basis to provide the basis of clinical treatment programs in ensuring quality health care under the premise of clinical pathways to improve the formulation and management,to more effectively control health care costs and improve patient satisfaction,clinical pathways makes a wider range of more in-depth development of clinical research,for clinical path forward further improve the program and authorized the formation of the industry for promoting the application of traditional Chinese and western medicine.