This article elaborates the concept, meaning and role of clinical pathway, discusses development stages and implementation effects of clinical pathway at home and abroad, and proposes that clinical pathway has been developed very well abroad, but it still has many problems in domestic gtowth which needs to be put into effect with Single-DRGs system in combination.
ObjectiveTo analyze the clinical manifestations and pathological patterns of renal diseases requiring percutaneous renopuncture, evaluate the clinical significance of renal biopsy and the value of clinical pathway for renal biopsy. MethodsWe retrospectively summarized and analyzed the clinical and pathological data, and the clinical pathway implementation of 224 patients who underwent renal biopsy between October 2009 and September 2014. ResultsIn the 224 patients, there were 62 cases of IgA nephropathy (27.68%), 50 cases of minimal change nephropathy (22.32%), 28 cases of lupus nephritis (12.5%), 26 cases of membrane nephropathy (11.6%), 26 cases of mesangial proliferative glomerulonephritis (11.6%), 6 cases of purpura nephritis (2.68%), 4 cases of focal segmental glomerular sclerosis (1.79%), 4 cases of hepatitis B virus-associated membrane nephropathy (1.79%), 4 cases of nodular diabetic glomerulosclerosis (1.79%), 4 cases of acute tubulointerstitial nephropathy (1.79%), 2 cases of hypertensive renal damage (0.89%), 2 cases of membrano-proliferative glomerulonephritis (0.89%), 1 case of lipoprotein kidney disease (0.45%), and 1 case of fibrillary glomerulopathy (0.45%). A total of 220 specimens in the 224 cases were qualified, accounting for 98.21%. Diagnosis of 70 patients in the qualified 220 cases were re-corrected according to their renal pathology reports, accounting for 31.81%. In the 224 cases, there were 16 cases of gross hematuria (7.14%) and 24 of peri-renal hematoma (10.71%) after renal biopsy. Patients who met the requirement of clinical pathway were divided into clinical pathway group and control group randomly. Average hospitalization time of the clinical pathway group was (7.6±1.2) days, and the average cost was (5 860±237) yuan, both lower than the control group [(11.8±2.3) days, (7 658±360) yuan)]. The difference was statistically significant. ConclusionsIgA nephropathy is the most common pathological type of primary glomerular diseases, and minimal change nephropathy the second. Lupus nephritis, membranous nephropathy, mesangial proliferative glomerulonephritis are still the most common types of glomerular diseases. Lupus nephritis becomes the first secondary glomerular disease. Ultrasound guided percutaneous renal biopsy is safe and has high success rate and high clinical application value. The implementation of clinical pathway can shorten the average length of hospital stay and reduce the average hospital cost.
Objective To analyze the significance of operation date in clinical path designing of cleft lip-palate. Methods The case records of cleft lip-palate patients from 8 hospitals in Gansu province were collected from 2005 to 2008. By means of comprehensive analysis of case records and frequencies of hospitalization duration, analyzed the influence of operation date selection on hospitalization duration in clinical path designing. Result In Gansu province, the average hospitalization duration of cleft lip-palate was 11 days, and the operation was usually done at the sixth day. The main preparations for operation were kinds of examinations. Within five days after operation, most treatments were postoperative care, diet and antibiotic therapy. Conclusion The strategy of operation date selection is much important to ascertain the real hospitalization duration in clinical path designing.
The two factors that affect enrollment of participants and the process of intervention in randomizedcontrolled pragmatic trials are similar to the situation of clinical practice, thus its effects are similar to the situation ofclinical practice. Therefore, when one estimates an intervention’s effect on a patient, it will be more similar to a real clinicalsituation than results taken from an explanatory trial. Due to the introduction of interventions and process variables usedin a pragmatic trial that conform to traditional Chinese medicine and acupuncture practices, more and more interest isgrowing among researchers in the traditional Chinese medicine field. This article introduces the principles and conceptsof the pragmatic trial, and the key points of design via some samples.
Objective To explore a scientific disease cost accounting. Method Disease cost accounting = disease cost accounting of clinic pathway + disease basis cost accounting. Conclusions It is the tendency with the medical reform for the social security department to pay by disease for the hospitals, as a result, both social security department and hospitals have to resort to the scientific way in terms of cost accounting of disease. And it is practical and effective by means of cost accounting for clinic pathway.
社区获得性肺炎( CAP) 是严重威胁人类健康的常见疾病之一, 但在其诊断和治疗仍存在相当大的差异。临床路径( clinical pathway, CP) 是一种新的临床诊疗规范管理方式,近年来开始应用于CAP 的临床诊治, 陆续有协会组织开始制定关于CAP 的临床路径, 并应用于临床。
Objective To investigate the efficacy of improved clinical nursing path for day surgery of laparoscopic cholecystectomy (LC). Methods The clinical data of 3 274 patients who underwent day surgery of LC following the clinical pathway between January 2011 and December 2015 were collected. The rate of adverse events including pain, postoperative nausea and vomiting (PONV), retention of urine and staxis before and after the improvement of clinical nursing path was analyzed and compared. Results For adverse event rate before and after the improvement of clinical nursing path, the difference in the incidence of pain and PONV was statistically significant (P < 0.05), while the difference in retention of urine and staxis was not statistically significant (P > 0.05). Conclusions Through the improvement of clinical nursing path for LC during day time, the procedure of nursing becomes more standardized. It is more feasible for clinical work and postoperative adverse reactio n rate becomes lower. It can also help shorten postoperative rehabilitation time and ensure perioperative medical quality and safety.
目前，国内尚未制定出较为完整的康复医学专业常见骨关节疾病的康复临床路径，为适应现代康复医学发展的需要，四川大学华西医院康复医学科根据卫生部《临床路径管理指导原则》要求，结合康复医学科住院患者的疾病、康复评定、康复治疗、康复护理、康复教育等，于2011年制定了康复医学科常见疾病的康复临床路径，希望通过临床试用，对路径的临床实用性、可行性进行探讨，并逐渐完善。
In combination with the national health informatization construction in UK during the past ten years, this article introduced the resource construction of decision making knowledge library like British Electronic Medicine Library Clinical Pathway Database and NHS Evidence, as well as the function and application of clinical decision support system (CDSS) like PRODIGY, medical knowledge map and so on, discussed the development characteristics and construction experiences of British health decision support system (HDSS). And aiming directly at Chinese specific circumstances, this article offered some suggestions on promoting China HDSS development, for instance, dynamically integrating CDSS with patients’ diagnosis and treatment procedure through the electronic medical record system, strengthening the resources construction of knowledge library, establishing localized clinical pathway, and so on.
Objective To analyze and evaluate the present status of application of clinical pathway evaluation indexes in China, in order to provide references to establish an evaluation system on clinical pathway. Methods Such databases as CBM (2004-2009), VIP (2004-2009), CNKI (2004-2009) and WanFang Data (2004-2009), and some relevant websites were searched systematically for collecting Chinese literature about domestic clinical pathway evaluation indexes. Results Among the 1 175 articles included, 135 (11%) were published in the core periodicals, 19 (2%) were masterate theses, and 1 021 were other kinds of articles. As to 135 core periodical literature and 19 masterate theses, most of which were graded into the second level of evidence, accounting for 96%. The analysis on the appearance of indexes showed that 87% of inconsistency could be identified between the contents and terms of indexes. Common indexes were summarized as the following four aspects: cost index, clinical index, serving index and quality evaluation index. There were 78% of all the 1 175 articles focusing on the application of nursing and medical education, in which only one masterate thesis used social research methods such as Delphi, focus group, experts scoring (percentile), etc. Conclusion Currently, there are some issues existing in the evaluation indexes of clinical pathway in China, such as low methodological quality of literature, irregularly and randomly using statistical terms, and lack of studies on system construction of clinical pathway evaluation indexes.