An Evaluation Of The Effects Of Clinical Pathways On The Average Length Of Stay And Average Expenses Of Inpatient Care For Specific Diseases In One Secondary Hospital In Shanghai

BackgroundThe concept of clinical pathways originated in 1970s in USA. U.S. Medical expenses raised sharply in the 1970s and thus the federal medical system and finance were overburdened, against which Diagnosis Related Groups system proposed by.researchers from Yale University was taken by the federal government as law for inpatients who had medical insurance and medical institutions proposed the concept of clinical pathways in order to reduce the growth of medical service cost and improve the utilization ratio of health resources, and finally to control the medical costs without hurting medical service quality.With the rapid growth of senior population who has chronic diseases and the rise of healthcare and longevity expectations, the Chinese medical service institutions also face high medical service cost, and are to use limited medical resources rationally to provide people with good, efficient, cheap and suitable medical service, as a result, the concept of clinical pathways was introduced into China, and promoted and developed quickly because of satisfying the various needs of hospitals and patients.ObjectivesThis study aimed to evaluate the effects of clinical pathways on the average length of stay and average expenses of inpatient care for specific diseases in one secondary hospital from 2010 to 2012 by analyzing various elements that affected the clinical pathways application to find some shortcomings and provided decision making basis for continuously improving clinical pathways application in the hospital. The results helped us evaluate the actual influences of improving health quality and alleviating medical burdens on patients.MethodsLiterature reviews were conducted for understanding the current conditions and problems of clinical pathways. Descriptive analysis was used for illustrating the overall application at the hospital. Randomized block test was used to analyze the average length of stay while Kruskal—Wallis H test was used to analyze the average expenses of inpatient care of ten diseases including nodular goiter, chronic sinusitis, tubal pregnancy operation, planned cesarean section, hyperplasia of prostate gland, colorectal polyps, chronic obstructive pulmonary disease(COPD), cerebral infarction, type 2 diabetes and bronchopneumonia. The influential factors of clinical pathways were found based on the combined results of literature reviews and qualitative interviews.ResultsThe main results of this research are:1、After clinical pathways application, the average length of stay of the inpatients with the following diseases as type 2 diabetes, cerebral infarction, colorectal polyps, nodular goiter, planned cesarean section, tubal pregnancy operation and hyperplasia of prostate gland, nodular goiter and tubal pregnancy were shortened. The average preoperative length of stay of nodular goiter and tubal pregnancy operation were shortened.2、The evaluation of average expenses of inpatient care:after clinical pathways application, the average expenses of inpatient care of cerebral infarction, nodular goiter, planned cesarean section and tubal pregnancy operation went up; the average medicine fees of inpatient care of chronic sinusitis and colorectal polyps were reduced, conversely, the cost of type 2 diabetes, cerebral infarction, COPD, nodular goiter and planned cesarean section went up; the average check fees of inpatient care of COPD was reduced while the cost of chronic sinusitis went up; the average laboratory expenses of inpatient care of colorectal polyps, COPD and chronic sinusitis were reduced, conversely, the cost of cerebral infarction, bronchopneumonia, planned cesarean section and tubal pregnancy operation went up.3、Various elements that affect clinical pathways application include policy factors, organization factors, medical personnel factors and patients factors.DiscussionsThrough the quantitative analysis and qualitative study of the effects of clinical pathways, this study shows that implementing clinical pathways produced two positive impacts on health care:①shortened average length of stay and increased healthcare efficiency; ②effectively controlled the irrational raise in the expenses of inpatient care.On the other hand, there are still some problems in the following six aspects during the clinical pathways implementation: ①irrational disease choice;②lack of analysis on variation reasons;③lack of nursing process monitoring;④lack of support of information system;⑤lack of cooperation mechanism of multisectors;⑥ lack of unification of clinical pathways standards and requirements from quality control center.According to the effects and experiences of clinical pathways implementation, the hospital should:①perfect clinical pathways management system and establish multisectoral clinical pathways application groups;②strengthen the analysis on variation reason;③explore and gradually establish the information platform for clinical pathways management and do clinical pathways dynamic management well; ④establish and perfect comprehensive performance evaluation mechanism;⑤perfect clinical pathways contents and control unreasonable expenses of inpatient care.