| Research purpose and meaning:Play a larger role in the clinical pathway (CP) as a standardized management approach, and effectively shorten the hospital stay, lower medical costs, and ensure health care quality and safety. In2009, the Ministry of Health in the nationwide implementation of the CP management, to implementation and evaluation as the reform of public hospitals, to promote the continuous improvement of quality of medical care to be implemented. This project conform to the requirements of the Ministry of Health, a three Cancer Hospital of the province, for example, efficiency indicators, the implementation of indicators, economic indicators of CP implementation of measuring and evaluating evidence-based thinking as a guide, the system found and multi-factor, localization analysis, and corresponding control response, and strengthen our province CP management, promote the establishment of neoplastic diseases of the situation in the province CP management practices.Research methods:1. Through the literature search, summarized and CP implementation of the evaluation indicators and methods of assessing the effects of a comprehensive analysis of the common characteristics of the tumor disease.2. Economic evaluation of the average cost of hospitalization before and after the implementation of the five most common cancer diseases CP, drugs, inspection fees, treatment fees, surgical fees, bed charges, other fees7.3. Statistical analysis, using SPSS15.0software to describe the average hospitalization days, the average hospitalization expenses and composition, diameter ratio and diameter after entering into the completion rate of digital characteristic, using X2test, t test, Wilcoxon W nonparametric test to carry on the statistics, comparison, analysis.4. Questionnaire volume survey method:According to Guo-tert-rock clinical path management key link in the table, homemade impact of clinical pathway factors survey table, each disease issuance questionnaire50, a total payment of250, to recover the214, which effectively questionnaires197, the total The recovery rate of85.6%,92.1%efficiency.5. depth interviews:Around the questionnaire and personal dialogue interviews (12), the relevant experts. Followed by a summary and analysis, to complement the quantitative data. Each disease is at least interview a director of a clinical expert.:Disease characteristics, CP cause analysis (personality, common problems), and suggestions.Results:1. An average length of stay:CP group and CP group were statistically significant. The CP group of cervical cancer than non-CP group, the other four diseases, the CP group than the non-CP group.2. CP group average length of stay compared with the standard length of stay:At least95%of thyroid cancer,75%of patients with cervical cancer standards; the compliance of about60%of breast cancer patients, but more volatile; the standard of50%in patients with colon cancer; knot A only25%of patients compliance.3. Average cost of hospitalization:nodular goiter, colon, breast, CP group is less than the non-CP group, with statistical significance. The CP group of cervical cancer than non-CP group, but also statistically significant.4. Cost components:four diseases cost components in descending order of drugs, surgical fees, inspection fees, treatment fees, bed charges, in addition to cervical cancer. Cervical cancer screening costs in first place, the rest of the order as above. Breast cancer the most effective CP, the various costs between groups were statistically significant; effective colon CP, were statistically significant in addition to drugs; knot A CP is controlled in terms of drugs, treatment fees, bed charges; thyroid cancer, CP control inspection fees, treatment fees; cervical cancer CP is counterproductive, in addition to inspection fees, with significant differences.5. Into the path rate:more than50percent of the only knot A and thyroid cancer. Knot A (77.9%). breast cancer (30.3%). Five disease into the diameter ratio (51.8%).6. The CP group completion rates:five disease greater than70%, the highest thyroid cancer (98.1%), colon cancer, the lowest (74.2%). Five disease overall completion rate (87.8%).7. Synergies among the poor in7. Affect tumor CP main factors:disease staging, complications,68.0%more; departments57.9%; medical staff do not know the path to place43.1%; a single path from the clinical practice41.1%; patients with the individual needs of37.6%; nervous beds24.9%; regulation in place by22.8%; postoperative complications,21.3%;18.3%of patients do not understand the path;10.2%of the health care clinics conflict.Conclusion:CP is a better model of clinical quality management, the sample implementation of effective hospitals CP, but the need to strengthen management. The serious condition of neoplastic diseases, easy to relapse, treatment means more complex and changing patient outcomes, the CP program is set to appear single, local and multi-disciplinary collaboration is not enough. Combined medical staff of CP awareness, lack of quality health care resources and other reasons, led to the implementation of some diseases is not enough, lack of supervision, management is not satisfied with, should effectively increase the implementation and supervision. Control strategies:1. A clinical pathway is the co-supervision of the Government and the Hospital and effort to complete a systematic project. CP management efforts should increase, in-depth manner.2. In cording to differdent diseases develop into diameter rate and completion rate standards.3. The formulation and implementation of clinical path should adhere to evidence-based thinking, to develop multi-channel management practices in accordance with local and disease characteristics, making it more localization, local, and professional characteristics.4. To increase the supervision and management of CP. Unify their thinking, focusing on multi-disciplinary collaboration to strengthen the dynamic management of information technology, increasing internal and external advocacy and patient communication, regulate the use of strict drug. |
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