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.
Objective To investigate on the epidemiologic characteristics of nosocomial infection in surgery departments of general hospitals by analyzing the data collected from documents which were published in recent years, so as to provide references for the construction of precautionary system model. Methods Applying comprehensive search strategies, we searched various electronic databases as CBM (1978 to 2008), CNKI (1912 to 2008), VIP (2001 to 2009) and WanFang Data (2001 to 2009). MeSH terms and/or text words included: nosocomial infections, cross infection, hospital infection, prevent and control. Data from top and second grade hospital were included in this analysis. Results Sixty four articles and a total of 1 990 929 inpatients were included. Results showed: average nosocomial infection rate was 4.46%; the total rates of medicine department and surgery department were 23.28% and 17.33% respectively and no significant difference was found between the two departments; the infection rates of G– and G+ germ were 47.71% and 21.31% respectively; the rates of average antibiotics use was 60.59% and the rate of missing report was 12.42%. Noscomial infection was related to season change and the wave peak was from February to May. Conclusion Most of the included studies were retrospective studies and cross-sectional studies. The type of data was inconsistency and incomplete, causing weak strength of evidence. High missing rate of reports makes the precautionary model hard to build in future.
Objective To enhance medical quality evaluation by conducting a systematic review and evidence-based synthesis of relevant research. Methods Such databases as CBM (1978 to 2009), VIP (1989 to 2009), CNKI (1990 to 2009), WanFang Dissertation database (1997 to 2009), and relevant websites were searched to identify relevant Chinese studies for the synthetical evaluation on methods evaluating medical quality. Results A total of 216 articles including 184 observational studies, 29 traditional reviews, and 3 experts’ opinions were identified. Twenty-one synthetical evaluation methods were used among 216 articles, and the top three methods which had been quoted more than 30 times were: RSR (19.72%), TOPSIS method (19.03%), and comprehensive index (12.80%). Among the 184 observational research papers, the documents using one kind of comprehensive evaluation took up 89.13% (164/184), the ones using two kinds of evaluation methods accounted for 9.78% (18/184), and those using three kinds of methods accounted for 1.09% (2/184). Conclusion a) The joint use of two or more than two methods is not common. The majority of studies using single comprehensive evaluation method focus on RSR, TOPSIS and comprehensive index method; b) The comprehensive evaluation method is considered non-uniform, some not even standardized; c) Most of the medical literatures do not correct the value of quality assessment; and d) Considerably most studies perform retrospective evaluation with historical data.