Medical network - on December 14, a clinical pathway is a pointer to a disease to establish a set of standardized treatment mode and treatment procedures, designed to standard medical behavior, reduce costs and improve quality. Since 2009, the original health radical 8 clinical pathway, the recently released 1010, several times of clinical path amplification mature enough to verify its promotion work.
Both from the medical treatment quality control, and health care cost Angle, clinical pathway has been given. In seven years in the process of the localization of landing in China, different hospitals of practical experience and encounter difficulties, is worth thinking about and referencing.
Seven years of clinical path mature "road"
As import "clinical pathway", in the United States at the beginning of the birth control is the main task of the medical expenses. Its official boarded the stage of the American medical is in 1983. When the United States just experienced the 60 s to 80 s personal medical expenses of high-speed growth, on the verge of urgently needs to solve the problem of control cost and clinical pathway is almost arises at the historic moment.
China started later, in 1996 by George mason university, Dr Tienwei tsai wu to the nursing profession introduction of the concept of "clinical pathway". Since many years, although some hospitals were sporadic attempts, but always not too big. It was not until 2009 that the fate of the clinical pathway in China.
This year, signature file "of the central committee of the communist party of the opinions of the state council on deepening the reform of medical health system" as mentioned in the "standard medical behavior", is to rely on clinical pathway management. In June the same year, the ministry of health issued "notice about print and distribute 8 disease clinical path, make long-term marginalized" clinical path "in the country.
The next seven years, the national health development planning commission post many times gradually expanding the scope of the clinical pathway to carry out the units and implement diseases. Released in early 2016 "about print and distribute to further improve the medical service action plan notice, at the end of 2017, all tertiary hospitals and 80% of secondary hospital clinical pathway management. Another according to official statistics, until the end of November 2015, the national 1599 4563 tertiary hospitals, secondary hospitals to carry out the clinical path management (the national altogether 2123 tertiary hospital, secondary hospital, 7494).
At the same time, the national health development planning commission recently announced 1010 clinical pathway. Thus, paving the way "" seven years of clinical pathway management, both from the disease types and breadth of the unit, its promotion has long been on track and becoming mature.
Step-by-step clinical pathway of "soft landing"
In addition to the policy for the national level, because in the standard medical behavior, medical quality and safety of outstanding performance, many hospitals are in the practice of clinical pathway. Health industry through combing found that although the clinical path on the surface is a paper treatment plan, but it is linked together, each ring is very high to the requirement of hospital management ability.
Start in early 2013, the Chinese people's liberation army general hospital clinical pathway "soft landing" project, selected from 1306 kinds of clinical pathway out of the 143 diseases, in the more perfect operating software and the new development of clinical pathway management under the help of monitoring and evaluation system, will cover more than eighty percent of the patients with disease hospital path to the ground.
But ACTS as a clinical pathway eventually fall to the ground, the doctor for the content of the clinical pathway contributed a major force. Dongfang hospital affiliated to tongji university (hereinafter referred to as Oriental hospital), for example, each issued a new path, first link is to reference guide clinical doctors will be worked out by the first draft. Then through medical department and the medicine, the medical department to participate, to determine the path of need of medical, pharmaceutical and other factors can be secure, and is determined by the medical department final format.
In addition to clear the development process of the clinical pathway, application data and text format, taizhou grace medical center (group) (hereinafter referred to as grace medical center) has also established the department of personalized management by objectives, and to set up the annual target and operable examination standard, clear the gap between each department in the process of execution, has played a good role in promoting. In addition, grace medical center in domestic takes the lead in the implementation of clinical pathway in patients with version, will be treated each "set" transparent, to monitor the whole process of hospital, the main clinical activities and management, let the victim plainly see the doctor.
Talk to single control clinical path management fees will not do it
For a long time, clinical pathway management is considered to ensure that the key of the health control cost, and the unilateral role in controlling health care costs is very limited, with medical quality control, performance evaluation, medical service fee payment adjustment, reform and the combination of medical informatization.
Therefore, anhui and zhejiang shall practise a system of "clinical pathway + press macro-reforms" reform, explore the macro-reforms floating quota management mechanism; Beijing insists on ten years DRGs payment, the balance between both medical cost control and quality assurance, to form the Beijing version of the clinical pathway. In other words, a clinical pathway as the basis of press disease to pay and to carry out the DRGs, become a booster of the reform of local medical insurance payment.
However, clinical pathway management in the hospital promotion was not all plain sailing. First of all, for under the secondary hospital, whether it is able to formulate or refine the path of experts, management of clinical pathway enough to know that, or standardized habits good doctor, is very scarce. Second, the implementation of clinical pathway also involves hardware problem - a set of perfect hospital information system, can let the doctor falls in love with it. And how to make clinical doctors actively embracing clinical pathway, rather than "for travel money away form", and hospital managers need to think about problems. |
