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| Nearly 9 percent of public hospitals have conducted clinical pathway management to put medical "wayward" into the cage |
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| Author：中國銘鉉 企劃部 Release Time：2017-8-24 11:02:32 Number Browse：699 |
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Nearly 90% of public hospitals have conducted clinical pathway management --
Put medical "petulance" into the cage
When li, 74, participated in his treatment with the "healthy enze" App, it was not known that it was a "clinical pathway".Recently, the old man was admitted to zhejiang taizhou hospital because of choledocholithiasis, which is one of the 252 diseases covered by the clinical pathway of the hospital.
Stewards in the App, lee my grandfather through in the hospital just in time to learn every day what treatment is required, and what he need to pay attention to, "with this, from the hospital on the first day I knew it would be here for a few days, the doctor will do inspection, with what medicine, when surgery, all know, it makes my heart is steadfast."
The case was recently exchanged for demonstration at the launch of the national health and family planning commission.Participants in the communication include the relevant principals of the committee, the people's hospital of Peking University, the taizhou hospital of zhejiang province and the head of the affiliated hospital of jining medical college.At the meeting, the national health and family planning commission (NHFPC) announced that in the first quarter of this year, nearly 7,000 public hospitals in the country, such as taizhou hospital, had managed clinical pathways, accounting for 88.5% of the total.There are 1212 clinical pathways, covering more than 30 major clinical specialties.
This is clearly seen as a significant development.In fact, since the new medical reform, the government has repeatedly promoted the clinical path management as a major step.As early as 2009, the ministry of health (moh) issued the guidelines on the guidelines for clinical path management (trial) to build the constitution and identified more than 100 hospitals in 23 provinces (districts and cities) as the first pilot units.Last year, we will deepen reform of the medical and health system of the state council leading group in the "about further promote deepening medical and health system reform experience of several opinions, will boost the work experiences as important and tasks.
In the opinion of decision makers, the promotion of graded diagnosis and treatment, the strengthening of modern hospital management system, and even the reform of medical payment methods are inseparable from the support of clinical path management.The effect seems to be satisfactory.
What is a clinical pathway?It is a pointer to a disease or some kind of surgery for patients, has the scientific nature and the time sequence of care plan, its core is the key to an illness or surgery involved such activities standardized examination, treatment, care, to ensure that the patient at the right time, right place, get the correct diagnosis and treatment services.
Zhang junto, deputy dean of renmin hospital of Peking University, describes the clinical pathway as a cooking process."The braised fish is a good way to cook, which is a set of methods and standards, including how to marinate, when to cook, how often to cook, etc.The clinical pathway is essentially similar, just a little more complicated.For example, the treatment of thyroid tumor, what the doctors do, how the nurses help, how the family members fit together, there is a set of norms that can't do what they want to do.
Chen tsuno, the former President of taizhou hospital in zhejiang province, likens the clinical path to the navigation of the car."Car navigation is to take all the geographic information and the car's operation to guide the driver.The clinical pathway is to optimize the experience of people's understanding and treatment of diseases, and select the most efficient, efficient and convenient treatment plan to guide the doctor.
Although the average person is unfamiliar with the strong academic vocabulary, it is nothing new.In the early 1980 s, the U.S. government to curb soaring health costs, improve the utilization rate of health resources, namely in the form of law to determine the diagnostic basis of classification for the payment of advance payment system ".In this context, Karen Zander, a nurse at the New England medical center, is the first to use the clinical pathway.This method has been proved to be able to shorten the number of days of hospitalization, save nursing expenses, and achieve the expected therapeutic effect, which has aroused the attention of the medical community.
For people suffering from overhealth care and the suffering of a doctor, it is obvious that doctors should practice medicine and let patients understand the clinical path of the patient.The story of the affiliated hospital of jining medical college is typical.
In 2003, a patient surnamed lu underwent an acute appendicitis operation in the hospital, and found that the same treatment charges were very different. He had spent more than half the number of other patients and complained to the hospital.The hospital has been checked and treated, giving the patient a guarantee that the same treatment will be charged for the same treatment.Since then, the hospital has taken the lead in initiating the clinical path management reform to eliminate the profit-seeking behavior under the project.
According to jining medical college affiliated hospital, vice President of the class bo, 2003, the hospital by developing clinical pathway, cost estimates, eliminate the unreasonable treatment project, optimize cost structure, introduced a single diseases price plan and implementation.After a year of analysis, the cost of the disease was reduced by about 30 percent on the premise of improving the quality of treatment.Such as ventricular septal defect and atrial septal defect, the average hospitalization cost was reduced from 17,000 yuan to 10,000 yuan.
In fact, the effect is on the whole.The same is true for a home.National health development planning commission medical hospital authority yan-hong guo, deputy director, said since the implementation of clinical pathway, the average hospital from 10.5 in 2009 to the world of such confinement dropped to 9.4 in 2016 days, annual average drop of 0.22 days, by 10.5%.Implementation of clinical pathway of hospitalized patients with medical institutions general decline of medical treatment charge, charge structure more reasonable, the time of clinical pathway group were hospitalized costs increase basically were lower than that of non clinical pathway group.At the same time, the medical institutions that carry out clinical path management, medical quality and medical safety indicators are well controlled.The mortality rate, hospital infection rate and operative infection rate of the top 10 patients were low.
However, the promotion of clinical pathway is a test for hospitals and doctors.There are dozens of drugs that can be opened and now "optimized" for several.The check that you could have done is now not allowed.Such "discretionary power" compression is undoubtedly painful.In addition, it is also a problem to update the clinical path in time to respond to the progress and development of the technology.
Chen said that doctors at taizhou hospital were not accustomed to the introduction of clinical path management, and the clinical path of each department was reported to be difficult.This is clearly a protest or misunderstanding, because it is not the most suitable for the clinical path.However, this is not insurmountable.The taizhou hospital has gradually completed the reform through building consensus, strengthening training and full authorization."It is easy to be accepted and accepted by the clinical pathway through incentives and informationization to make the frontline doctors benefit and feel convenient."
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