A Study On Clinical Pathway For Its Effect Of Improving Medical Service And Controlling Medical Costs

Background:with the application of update medical devices and special Drugs and the people's continuously improving requirements of the medical service quality in recent years, the health costs increase rapidly. According to the data of Ministry of Health of China, the average growth rate of total health costs reached 13.5% from 1995 to 2004 annual, much higher than the growth rates of the GDP,government revenue and national income. And the residents accounted for more than 50% of the total costs[4].Excessive growth of medical costs is a problem for all of the countries, which the developed countries generally use Diagnosis Relatived Groups (DRGs) to control effectively. The United States created DRGs-PPS(Diagnosis Relatived Groups and Prospective Payment System) firstly in 1976. The HCFA (Health Care Financing Administration) published the DRGs codes firstly in 1983. the United Kingdom, Canada, France, Australia, Germany and other developed countries have introduced DRGs and modified to suit the needs of their own countries[1].However, "regional differences" in different hospitals effected the createment and the costs of the same disease after the implementation of DRGs.But the authority costs were lack of. Therefore, the Boston New England Medical Center Hospital (NEMC) selected some diseases in DRGs, established clear diagnosis and treatment norms, used health care plans according to the schedule during hospitalization, which could reduce the average days in hospital and medical costs and achieve the desired effect. The model was called clinical pathway(CP), which could achieve the continuous quality improvement (CQI),save resources and launch into single-disease quality management.CP has been paid universal attention to in Europe and Asia. The United States, Britain, Australia, Singapore, Japan, Taiwan of China have applied it, which effectively reduced the average days in hospital.controlled the medical costs, improved the patient's satisfaction and the hospitals'efficiency.The [2009] 111 document of the Ministry of Health of China issued eight clinical pathways. More than 100 CPs of the medicine, surgery, gynecology, pediatrics and other disciplines have been issued and required to pilot since then.The Phenomenons of relaxing Indications for admission, moving up the diagnosis, etc may appear because of selecting patients and treatment. CP also may limit the medical thinking and innovating, demand more cooperation between departments, etc. Therefore, the evaluation of CP can improve the managementThe hospital in the study is a medium general hospital, Civilization Unit, with 436 beds, more than 250 Senior medical staffs, more than 50 millions outpatients and 1.1 millions Inpatients annual,5 key medical specialties. CP has been applied in 12 diseases of 10 specialties since September 2009.Purpose:With the implementation of clinical pathway in the hospital, we compare the medical services, cost and efficiency, identify the Advantages and disadvantages, discover the difficulties, evaluate the effects, reference on the experience, Propose feasible suggestions. Methods:Combining with expert advice, individual interviews, questionnaires, literature analysis, we collect the Information of the whole hospital from September 2004 to August 2010 and the bills, medical records and satisfaction questionnaires of 1479 cases (339 cases of senile cataract) of 12 diseases in CP management from the Function departments to get the data of medical services, medical cost, medical efficiency to do longitudinal and horizontal studies to evaluate the effect of CP. Different statistic methods including retrospective analysis, individual interviews, expert consulation, satisfaction questionnaires, stata software, excel software, general descriptive statistics, T-test, etc were used to assess the effect of CP.Results:After the implementation of clinical pathway,1. Medical services:the brand appeared.the patients of implemented diseases was 33.48%,18.80% more than the data of last year, the Predictive value respectively, and the scales were higher than the whole hospital's level. The male ratio was 7.97%,8.92% higher than the data of last year, the Predictive value respectively in surgical departments, and the scales were higher than the whole hospital's level. The average age was 1.40%,1.67% less than the data of last year, the Predictive value respectively, while the whole hospital's scales were 1.18% more than the data of last year, 0.18% less than the Predictive value, the days in hospital were reduced, which of senile cataract were 15.42%,5.60%less than the last year, the Predictive value respectively, and the scales were higher than the whole hospital's level (major in the the young and males). Medical quality improved continuely, the cure and improvement rate was 2.69%,3.20% more than the last year, the Predictive value respectively, while the whole hospital's level fell.The satisfaction of Senile cataract patients improved from 98.56 of 2008 to 99.70 of 2009, and there were the significant statistical difference (P<0.05). The income of Ophthalmology staff was 20.32%,7.96% more than the last year, the Predictive value respectively. The satisfaction of the doctor s and nurses increased significantly.2. Medical costs:the costs of surgical departments were only 3.70%,1.11% more than the data of last year, the Predictive value respectively, while the whole hospital's scales were 13.17%. The costs in ophthalmic were 2.39%,5.86% less than the last year, the Predictive value respectively. Drug costs of inpatients were 6.33%,14.74% less than the data of last year, the Predictive value respectively. The net income was 7.68%,3.43% more than the data of the last year, the Predictive value respectively. For the Senile cataract patients, the numbers of examination induced, especially in the elder and female. The average hospital costs were less 7.47%,8.14%than the data of the last year, the Predictive value respectively especially in the young and males. The ratios of surgical material costs were 27.13%,30.76% more than the data of the last year, the Predictive value respectively,because of the expensive IOLs for the Medical Safety.3. Medical efficiency:the growth rates of total assets and assets per bed increased. In surgical department, the costs per bed were 9.87%,4.66% more than the data of the last year, the Predictive value respectively. In Non-surgical department, the costs per bed were 14.74%,1.79% more than the data of the last year, the Predictive value respectively, while the whole hospital's scales were 19.82%,3.51% respectively. The bed occupancy rates of ophthalmology were 11.44%,3.18% more than the data of the last year, the Predictive value respectively. The outpatients per staff were 19.63%,11.00% more than the data of the last year, the Predictive value respectively.The bed days per staff were 5.97%,6.98% more than the data of the last year, the Predictive value respectively.4. Study of variance:The senile cataract patients with the positive variance were younger, less days in hospital, higher female ratios, more bed costs per day, higer checking costs ratios and lower cure and improvement rates. The senile cataract patients with the negative variance were elder, more days in hospital, higher female ratios, less bed costs per day, higer checking costs ratios and cure and improvement rates. Conclusion:Although the CP may cause the selection for patients and treatments and it's difficult to control the variance, the CP can Enhance the brand, raise the satisfaction, reduce the days in hospital, promote Reasonable use of drugs and examinations, control the medical costs effectively and improve the quality and efficiency of medical services continuously.