Based on the practice of large tertiary hospitals in clinical pathway (CP) entrance management, we implemented a fine CP management model with standardized clinical diagnosis and treatment, and encouraged the department to continuously optimize the path form, expand CP coverage and improve the entry rate in a flexible path. Combining PDCA cycles with CP management, it can promote the realization of management goals and achieve continuous improvement, while providing operable (repeatable) methods to the practice of hospital CP management.
Strengthening the management and evaluation of clinical pathways is one of the most important strategies of "Healthy China 2030" Strategic Plan. Evidence-based assessment and clinical guidelines can provide the best relevant evidence to develop clinical pathways. We planned to analyze the current situation of clinical pathways in China and explore how to apply evidence-based assessment on clinical pathway management. We searched PubMed, EMbase, ISI, CNKI, WanFang Data, VIP and the The Cochrane Library using "critical pathways" and "clinical guidelines" as key words or subject terms. And we conducted a comparison of their published volume, definitions, differences and connections. The management system of clinical pathway in China is fundamentally flawed, it is still a challenge to implement the clinical pathways effectively without scientific methodologies and standardized evidence-based evaluation system. In order to improve the management quality of clinical pathway in China, we should develop clinical pathways based on national situation and innovate the evaluation system to standardize the clinical pathway management according to WHO recommendations of clinical guideline and appraisal.
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.
ObjectiveTo explore the effectiveness of clinical pathway (CP) in patients underwent laparoscopic cholecystectomy (LC). MethodsA retrospective, case-matched, and clinical controlled study was applied. We selected patients with acute calculous cholecystitis (ACC) who were hospitalized in 363 Hospital and underwent LC between September 2012 and August 2013, and divided them into two groups (non-CP vs. CP:2 to 1) according to sex, age (±5), nation and complications. The indicators including length of stay (LOS), antibiotic usage and per-average hospital expenses were compared between groups. Data were analyzed using SPSS 13.0 software. ResultsA total of 1 044 patients were included, of which 348 were assigned to CP management (CP group), while the other 696 patients were 2 to 1 matched with those in the CP group. Compared to the non-CP group, the pre-operation LOS and total LOS in the CP group were shortened by 1.23 days and 2.08 days, respectively (P < 0.05); the per-average hospital expenses and per-average expenses of drugs in the CP group were decreased by ￥604.7 yuan and ￥287.5 yuan, respectively (P < 0.05); and the rate of antibiotic and non-restricted antibiotic usage in the CP group were dropped by 4.4% and 7.0%, respectively (P < 0.05). There was no significant difference between the groups in efficiency, hospital-related infection rate, the incidence of adverse events, the restricted and special antibiotic usage rate (P > 0.05). The variation coefficient of patients included in the CP group was 15.8%, and the time which did not meet the admission requirement of CP was the main reason for this variation (27, 49.1%). ConclusionClinical pathway could shorten the LOS and cut down the total hospital expenses. However, multidisciplinary cooperation is still needed, and we should optimize the CP processes continuously and enhance the flexibility of CP, so as to improve the quality of medical service.
ObjectivesTo analyze the citation of evidence in traditional Chinese medicine (TCM) clinical pathways in China, and to provide suggestions for future development and revision of TCM clinical pathways.MethodsTCM clinical pathways released on the websites of national administration of TCM and China association of Chinese medicine were obtained, with the retrieval time limit to June 2019. Two researchers separately utilized the Excel to extract data and performed a descriptive analysis.ResultsA total of 405 TCM clinical pathways were included, involving internal medicine, surgery, gynecology and pediatrics. Internal medicine accounted for the largest proportion of the TCM clinical pathways (133). All the 405 pathways cited references as evidence, among which the maximum and minimum quantities of cited references were 11 and 1, respectively, and the median was 3. More than 90% of the TCM clinical pathways cited the evidence in the parts of diagnosis and efficacy evaluation. For parts of TCM and western medicine treatment, the proportion of TCM clinical pathways which cited evidence was less than 75%; for parts of rehabilitation and nursing, the proportion of TCM clinical pathways which cited evidence was less than 2%. The types of evidence being cited were standard indicators (683), clinical practice guidelines (488), textbooks (236), consensus opinions, ancient books and clinical surveys. The released time was reported in 89.25% of the cited evidence; the largest time interval was between the release time of the standard indicators (evidence) and that of the TCM pathways. Among the evidence released more than 15 years before the release of the TCM pathways, the proportion of standard indicators was the highest (57.12%).ConclusionsThe published TCM clinical pathways are all developed based on evidence, however, the evidence citation ratio in different parts varies greatly. In some TCM clinical pathways, the cited evidences are not reported normatively, and some evidence are poor in timeliness.
Exercise prescription is an effective tool for the prevention and control of hypertension, diabetes and dyslipidemia. However, a full set of exercise prescription is difficult to be implemented in China's primary medical institutions and community public health service centers. Therefore, under the support of the theoretical system of exercise prescription and the standard development norms, this clinical pathway of exercise prescription is developed according to the characteristics of national physical fitness and the status quo of primary healthcare institutions in China, aiming at simplifying the process of exercise prescription development, reducing the professional threshold, empowering primary healthcare, and providing a scientific and feasible solution for the promotion of exercise prescription in primary healthcare institutions.
Objective To evaluate the feasibility of the clinical pathway based on the medical data information integration system to guide the treatment of palmar hyperhidrosis (PHH). Methods We retrospectively analyzed the clinical data of 106 PHH patients in the Fourth Affiliated Hospital of Harbin Medical University from March 2012 through June 2015. The patients were divided into two groups including a day surgery group (52 patients) and a traditional group (54 patients). The patients in the day surgery group underwent day surgery guided by clinical pathway of PHH based on medical data information integration system. The patients in the traditional group stayed in hospital for 2-3 days. The pre-surgical situation, post-surgical effect of patients and cost of hospitalization were compared between the two groups. Results Only one patient of PPH suffered from insufficient relief of symptoms. The other patients’ symptom of PPH disappeared. No serious complication occurred. The postoperative visual analogue scale (VAS) pain score of patients was lower than 2 points. The hospitalization expense of the day surgery group was significantly lower than that of the traditional operation group. The average follow-up time was 2.5 months (0.5 to 4 months). The symptoms of the whole group had no recurrence. All of the patients were not found with compensatory hyperhidrosis. Conclusion Day-surgery clinical pathway of PHH based on medical data information integration system is safe and feasible. Day-surgery clinical pathway of PPH can accelerate the recovery of patients and save the cost of hospitalization.
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.
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.
Since its first clinical application in 2002, transcatheter aortic valve replacement (TAVR) has grown from an exploratory technology to the cornerstone of the treatment of aortic valve disease. The release of 2024 Expert Consensus on Clinical Pathway for Transcatheter Aortic Valve Replacement in China marks a new phase of high-quality development for TAVR in China. This article will thoroughly interpret this programmatic document, comprehensively analyze its key links such as the basis of evidence-based medicine, preoperative clinical evaluation, perioperative imaging evaluation, standardized surgical process, perioperative comprehensive management and postoperative rehabilitation follow-up, explain its clinical path, provide comprehensive guidance for clinical practice, and help the majority of cardiovascular interventional physicians to move forward accurately in the new era of structural heart disease treatment.