Clinical Pathway Evaluation And Continuous Improvement System Research

Objectives:Through establishing a Clinical Pathways (CP) quality assessment system, ourstudy aims to evaluate the outcomes data of CP at pilot hospital sites over one year.The outcome categories evaluated include healthcare efficiency, healthcare quality,overhead costs, and more. This study analyzes the various elements that affect CPapplication, consolidates experiences from the pilot hospitals, and explores theinsufficiencies of CP applications. It provides specific recommendations andcomments for continuously improving CP application.Research Methods:Literature reviews were conducted for understanding the current CP conditionsand problems China. Delphi Method was applied to construct a CP quality assessmentsystem. The variables were then weighted and selected using Analytic HierarchyProcess (AHP). Descriptive analysis was used for illustrating the overall application atselected hospitals in China. Randomized block test, combining analysis of variance,was employed to assess quantity. Ishikawa Diagrams (also called Fishbone Diagrams)results analytically suggest the determinants of CP performance. Identification ofproblems and policy recommendations for improvements were made based on thecombined results of quantity analyses, interview and consulting.Results:1) For the cost index, average hospitalization expenses increased after CP wasapplied, but the speed of growth decreased. Shortened average length of stay(ALOS) resulted in a rapid increase of cost per day. On the other hand, thepercentage of medicine cost among average hospitalization expenses dropped,while no differences were observed on the percentage of cost on medicaldevice, comparing to previous years. 2) For the efficiency index, ALOS before surgery and total ALOS decreasedsignificantly. Bed distribution indexes demonstrated that hospital beds had ahigher usage frequency and better bed allocations after applying CP in thehospitals. Annual hospitalizations remain mostly the same, with some slightincrease in select hospitals.3) For the quality index, there are no significant differences before and after CPapplication for mortality rate, recovery rate, improvement rate, infection rateand re-hospitalization rate. However, CP does effectively reduce the averagelengths of antibiotics usage.4) For the resource allocation index, analyses focused on daily income per bed.The results indicated that hospitals from the east have higher income. Theirdaily income per bed in2010is between one to three thousand RMB. Thissuggests that CP does not negatively affect hospital income.5) Through qualitative research, we can conclude that determinants for CPapplication include policy factors, organization factors and individual factors.Discussion：This study shows that the implementing CP could lead to the following results.1) Implementation of CP is effective for increasing healthcare efficiency.2) Implementation of CP appears to effectively control the irrational medical costhike.3) CP effectively promotes the appropriate medication prescription.On the other hand, there are some problems for the following seven aspects:1) Policy measures for supporting CP implementation should be improved.2) Some hospitals did not strategically plan for the introduction of CP.3) Hospital information systems are not adequate for real-time management andevaluation of CP.4) Management and evaluation systems regarding variability in clinical practiceneed to be established. 5) Capacity for interdepartmental CP coordination remains a great challenge.6) Disease and protocol selections for CP should be better rationalized.7) Physicians and patients both need to become more aware and supportive ofCP.Recommendations:1) Improve CP and bend the irrational hike of medical cost curve.2) Actively coordinate with the Department of Health Insurance and theDepartment of Price to encourage payment reform.3) Include CP into the regulation system for access control administration inmedical care institutions.4) Explore and gradually establish the information platform for CP management.5) Increase coordination and cooperation among departments to improve theimplementation of CP.6) Variability on geographic locations and healthcare service levels should betaken into consideration for creating CP models.7) Expand publicity efforts to alter traditional health beliefs of health careproviders and patients.8) Grab on to the opportunities and promote the hospital reform pilot program.