| Summary: | 碩士 === 國立台北護理學院 === 護理研究所 === 91 === The purposes of this research were to develop a clinical pathway for patients with chronic obstructive pulmonary disease, and to test the effects of the pathway on length of stay, medical cost, dyspnea levels, endurance of exercises, satisfaction of the patients and medical personnel. The research was carry out in two stages: The first stage was to develop a clinical pathway for chronic obstructive pulmonary disease patients. Retrospective chart review method was used. The second stage was to test the effectiveness of the COPD clinical pathway. The study is a quasi-experimental design. Subjects include COPD patients, medical and nursing staffs. The study was carried out in a medical ward of a hospital in the northern Taiwan. Data were collected from the control group of 30 patients first, then the experimental group of 30 patients. Both groups of patients were matched with the disease severity. The first stage of collecting data was from September to October of 1991 while the second stage was from December of 1991 to April of 1992. The research instruments included basic medical record charts, Visual Analogue Scale of dyspnea, 6-minute walking test, Clinical Pathway Variance Record List, Patient Satisfaction with Nursing Care Questionnaire, and Six-Dimension Scal of Nursing Performance. Control group patients were cared with unit routine. Experimental group patients received care as indicated within COPD clinical pathway. The software SPSS 10.0 used for data analysis. The statistical methods included: mean, standard deviation, percentile, independent sample t-test, and ANCOVA.
The results indicated that clinical pathway for chronic obstructive pulmonary disease patients can effectively shorten length of stay (LOS). Mean of LOS were 12.0 days for the control group, and 7.23 days for the experimental group. The clinical pathway decreased medical cost significantly (p<.05). Mean of medical cost were $28885.50 in NT for the control group, and $13878.83 in NT for the experimental group. There was no significant difference on patients dyspnea levels and endurance of exercises. The pathway also improved the satisfaction of patients and the job satisfaction of medical and nursing staffs.
This study support that clinical pathway is an ideal medical management tool to reduce the length of stay and medical cost. Furthermore, the pathway could improve the satisfaction of patients and the job satisfaction of medical and nursing staffs.
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