Clinical pathway management of diabetic Charcot neuro-osteoarthropathy.

Peking University Third Hospital is one of the first hospitals for experiments in clinical pathway selected by the Ministry of Health,which keeps optimizing the clinical pathway management mechanism and function of information system in its 4-year practice.This article described the combination strategy of clinical pathway management and information system applications,in terms of reasonable design of the management plan,standardized clinical pathway,strengthened execution control and improvement of the quality control.The purpose is to balance the relationship between clinical pathway management norms and user-friendliness of the system,enhance rationality and feasibility,improve efficiency and provide high-quality service to ensure medical safety. Key words: Clinical pathway; Information systems; Strategy

Objective To investigate clinical nursing pathway management combined with nurse hierarchical system so as to promote the smooth implementation of clinical pathways.Methods The process of clinical nursing pathway was distributed into the work of nurses at different levels by using the present available resources; their process quality was quantitatively evaluated, which was closely related to their achievements, with the aim of making the nursing activity procedurized and standardized.Results Patients' satisfaction before and after implementing the clinical care pathway management combined with nurse hierarchical system was significantly different (P<0.01); the average hospital stay for a single disease was decreased after its implementation (P<0.05).Conclusions Implementing clinical nursing pathway management combined with nurse hierarchical system could effectively control the health care costs, improve quality of care and achieve the best possible care and management objectives. Key words: Nursing administration research; Clinical nursing pathway; Nursing quality

The paper covered the selection of clinical trial diseases in the clinical pathway experiment in the hospital in the recent two years.It also introduced such management measures as making clinical pathway texts,the rate of cases into clinical pathways,emphasis of variation management,and enhanced clinical pathway data analysis.A comparison between the groups before and after clinical pathway management,found that the clinical pathway can reduce the average days of stay and total patient costs by 3.4 days and 1519 yuan respectively.Both patients and hospitals benefit from clinical pathways.The paper also advocates continuous and dynamic management at various stages of clinical pathway management. Key words: Clinical pathway; Application; Management

Objective. To evaluate the clinical effects of implementing the clinical pathway management method. Methods. Comparing and evaluating the indexes of average hospitalization expense, average length of stay, preoperative average length of stay, and patient satisfaction, in two groups. One included 5268 cases of clinical pathway management for five diseases (clinical pathway group), and the other group included 5895 cases not treated under clinical pathway management (traditional group), from May 2010 to May 2013 in the hospital. Results. The differences in the average hospitalization expense and medicine expense of patients with nodular goiter, between the clinical pathway group and the traditional group, were not statistically significant (P > 0.05), but the auxiliary examination expense in the clinical pathway group was significantly decreased (P < 0.001); the differences in the average auxiliary examination expense for patients with simple appendicitis between the two groups were not statisticall...

Objective To analyze the effect of clinical pathway management on daytime surgery of adult patients with inguinal hernia. Methods Based on the application of clinical pathway, one hundred and twenty patients with unilateral inguinal hernia were recruited in Liaocheng People’s Hospital from January 2014 to June 2016, and were divided into clinical pathway group (observation group) with 56 cases and inpatient surgery group (control group) with 64 cases according to patients’ opinion. The length of stay, costs, surgical effect, postoperative complications and cost-effectiveness analysis were compared. Results There were no significant differences between the two groups in operation time, blood loss during the operation, or postoperative complications (t=0.397, 0.790, P=0.823, 0.430; χ2=0.250, P=0.617). Compared with the control group, the length of stay and costs were shorter in the observation group (t=10.851, 6.755, both P<0.001), and cost-effects were lower. Conclusion The clinical pathway management can significantly reduce the costs of stay, improve the efficiency with minimized medical risk and ensure the medical safety and quality. Key words: Clinical pathways; Hernia, inguinal; Day care

Predicting future state for adaptive clinical pathway management

BackgroundHospitals nowadays have to serve numerous patients with limited medical staff and equipment while maintaining healthcare quality. Clinical pathway informatics is regarded as an efficient way to solve a series of hospital challenges. To date, conventional research lacks a mathematical model to describe clinical pathways. Existing vague descriptions cannot fully capture the complexities accurately in clinical pathways and hinders the effective management and further optimization of clinical pathways.MethodGiven this motivation, this paper presents a clinical pathway management platform, the Imperial Clinical Pathway Analyzer (ICPA). By extending the stochastic model performance evaluation process algebra (PEPA), ICPA introduces a clinical-pathway-specific model: clinical pathway PEPA (CPP). ICPA can simulate stochastic behaviours of a clinical pathway by extracting information from public clinical databases and other related documents using CPP. Thus, the performance of this clinical pathway, including its throughput, resource utilisation and passage time can be quantitatively analysed.ResultsA typical clinical pathway on stroke extracted from a UK hospital is used to illustrate the effectiveness of ICPA. Three application scenarios are tested using ICPA: 1) redundant resources are identified and removed, thus the number of patients being served is maintained with less cost; 2) the patient passage time is estimated, providing the likelihood that patients can leave hospital within a specific period; 3) the maximum number of input patients are found, helping hospitals to decide whether they can serve more patients with the existing resource allocation.ConclusionsICPA is an effective platform for clinical pathway management: 1) ICPA can describe a variety of components (state, activity, resource and constraints) in a clinical pathway, thus facilitating the proper understanding of complexities involved in it; 2) ICPA supports the performance analysis of clinical pathway, thereby assisting hospitals to effectively manage time and resources in clinical pathway.

Objective To analysis the clinical pathway management efficiency under different DRG groups, for a basis for further optimizing clinical pathway management. Methods The retrospective analysis method was used to compare the average length of stay, sub-average costs, and drug proportions of patients with different DRGs in the same clinical pathway.Shapiro-Wilk was used to detect the normality of the samples, t test was used to analyze measurement data conformed to the normal distribution, non-parametric test was used to analyze the abnormal distribution data, and enumeration data was detected by using chi-square test. Results For patients with a clinical pathway of bronchial pneumonia, patients with severe complications and concomitant symptoms had no significant difference in mean hospitalization and sub-costs, regardless of whether they completed or entered the clinical pathway(P>0.05). For the other two DRG patients, the difference between the average length of stay, sub-average costs, and the proportion of medications for patients who completed the clinical pathway and withdrew from or did not complete the clinical pathway was significant(P<0.05). In the severe surgical group, the length of stay and average cost for patients who completed the clinical pathway were lower than those who exited or did not enter the clinical pathway(P<0.05). Conclusions Patients with different severity of DRGs should be cautious when they are enrolled in the clinical pathway. Key words: Clinical pathways; Diagnosis-related groups; Length of stay; Average cost; Disease management

Objective To investigate the clinical effect of the clinical pathway management practiced by the Ministry of Health in the planned cesarean section.Methods 113 cases of pregnant women had been implemented by the clinical path management in planned cesarean section classified as path group,other 113 pregnant women who had not were control group.We made the comprehensive analysis on the hospital stay and all kinds of cost,the various elements' coefficient of variation and constituent ratio,patient satisfaction and postoperative complications in the two groups.Results The hospital stay and the total cost of hospitalization of the path group were significantly shorter than those of the control group.The average length of stay and postoperative recovery time were significantly lower than those of the control group (P＜0.05),and maternal satisfaction significantly higher (P ＜ 0.05).Conclusion The clinical pathway used in the planned cesarean section can standardize medical practices,reduce medical costs,and significantly increase maternal satisfaction. Key words: Clinical pathway management; Planned cesarean section; Preoperative use

Objective To build the indicators system for clinical pathway management as required by clinical pathway control.Methods An indicators system was proposed by means of evidence-based review,focus group discussions,and ratings of the indicators' importance by doctors and nurses.A multidisciplinary panel of 60 experts from across the country were selected.A 3-round Delphi survey was made on the proposed indicators.The weights of the indicators were established by analytical hierarchy process (AHP).The response rate,Cronbach's α,and the authority coefficient of experts were used as a measure of reliability.Results The response rates of the 3 rounds were 85％,70％,and 94％; the experts authority coefficient was 0.80.The ccoefficient of variation falls with the rising number of consultations.The Kendall's W ranged from 0.40 to 0.83.Following the 3 rounds,consensus was achieved among experts as such a system comprising three first-level,9 second-level,and 36 third-level indicators.Conclusion The expert consultation has achieved reliable results.The established indicators system can serve as a useful instrument for standardized development of clinical pathways management and constant improvement. Key words: Clinical pathway; Evaluation indicators system; Delphi method; Analytic hierarchy process; the Kendall coefficient of concordance

Objective To evaluate the application of clinical pathway for patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD) undergoing antibiotic administration. Methods One hundred and twenty six patients with AECOPD admitted from April 2017 to December 2018 were randomly divided into two groups: 63 patients in study group (63) received antibiotics treatment according to the clinical pathway and other 63 patients in control group received antibiotics according to clinical experience. The rates of sample submission and positive sputum pathogens, the rates of antibiotic use and its intensity, course of treatment, drug cost and combined medication, length of stay and costs of hospitalization were analyzed and compared between two groups. Results The sample submission rate and the positive rate of sputum pathogens in study group were significantly higher than those in control group [100.0% (63/63) vs. 90.5% (57/63), χ2=6.300; 44.4% (28/63) vs. 22.8% (13/57), χ2=6.229, P 0.05]. Types and rate of antibiotic usage in study group were lower than those in control group [9 vs. 12; 85.7% (54/63) vs. 96.8% (61/63), χ2=4.881, P 0.05). In study group, the combined antibiotics use rate was lower than that in control group [(41.3% (28/63) vs. (63.5% (40/63) , P=0.03]; the length [(7.63±3.95)d vs. (12.84±4.45) d, t=-6.939, P<0.01] and costs of antibiotics use [1 157 (745,2 002) Yuan vs. 2 063 (1 534, 2 811)Yuan, Z=-4.480, P<0.01], length of hospital stay [(11.43±3.53)d vs. (16.65±3.99)d, t=-7.785, P<0.01] and hospitalization expenses [(13 020±5 511) Yuan vs. (19 621±4 824) Yuan, t=-7.121, P<0.01] in study group were all significantly lower than those in control group. Acute exacerbation rate within 30 days in study group was not different from that in control group [9.5% (4/63) vs.6.3% (6/63), χ2=0.434, P=0.51]. Conclusion Application of clinical pathway management provides basis for rational use of antimicrobial drugs and for control of medical expenses for COPD patients with acute exacerbation. Key words: Clinical pathway; Pulmonary disease, chronic obstructive; Anti-bacterial agents; Evaluation studies

Clinical pathways have contributed to standardized postoperative management, but analyzing variance is also important to maintain quality control. To evaluate the validity of our own clinical pathway for managing video-assisted lobectomy for lung cancer, we analyzed the variances influencing postoperative recovery. Between April 2003 and April 2004, 62 consecutive patients with lung cancer underwent video-assisted single anatomic lobectomy with lymph node dissection. We evaluated 61 of these patients after the exclusion of one, who deviated from the clinical pathway management immediately as a result of serious complications. There were 29 men and 32 women, with an average age of 65.7 years. Complications developed in 29 patients, but there was no operative mortality. The occurrence of variance ranged from 1.6% to 34.4% for each activity and included prolonged supplemental oxygen therapy, out-of routine examination, prolonged epidural anesthesia, and delayed bathing frequently. Complications and an abnormal body mass index were significant and independent clinical factors affecting the increase in variance. Our original clinical pathway management was tolerable for lung cancer patients undergoing a video-assisted lobectomy. Complications and an abnormal body mass index were significant predictive factors for an increase in variance of our clinical pathway.

Objective Investigate the effect of applying clinical pathway on the patients undergoing leiomyoma of uterus. Methods As an experimental group of patients, 50 cases of uterine leiomyoma are treated with clinical pathway. By contrast, another 100 cases are treated with the traditional medical care as control group. Results Waiting time for surgery and hospital stay of the experimental group are less than the control group; and the average hospitalization cost of experimental group is lower than the control group (P< 0.01). Conclusions Application of clinical pathway management will regulate the activities of medical treatment, ensure the quality of health care, improve the feeling of patients, increase efficiency of hospital services, reduce the financial burden of patients, increase the hospital social benefits. Key words: leiomyoma of uterus; clinical pathway; hospital quality management

A clinical pathway defines the optimal multidisciplinary care process performed by a team of health care professionals for a particular diagnosis or procedure. Its computerized implementation in the web-based knowledge intensive environment is very important for the delivery of healthcare services with higher quality and efficiency. This paper proposes a framework for semantics-based clinical pathway and variance management to enable such implementation. A clinical pathway ontology (CPO) and relevant domain ontology are developed to serve as a common semantic foundation for the framework. In addition, a hierarchical approach and a temporal rule approach based on Semantic Web rule language (SWRL) are combined to semantically model the knowledge of clinical pathways including clinical outcomes, workflows and temporal relationships for clinical pathway workflow management. Moreover, the generalized fuzzy event-condition-action (GFECA) rule and typed fuzzy Petri net extended by process knowledge (TFPN-PK) models are presented to provide support for the fuzzy analysis and handling decision of different types of variances that occur during patient care processes following clinical pathways.

Clinical Care pathways, also known as critical pathways, integrated care pathways, case management plans, clinical care pathways or care maps, are used to systematically plan and follow up a patient focused care program. Clinical pathways are used all over the world and so for respiratory rehabilitation pathways (RR) and the importance of knowledge and learning Evidence Based Practice (EBP) is well known and mandatory. However, the EBP acquisitions of the home RR model and the knowledge of Clinical Care Pathways (PCA) are poorly defined.