title: Compliance with clinical pathways for inpatient care in Chinese public hospitals.
abstract: BACKGROUND
  The National Health and Family Planning Commission of China has issued more than 400 clinical pathways to improve the effectiveness and efficiency of medical care delivered by public hospitals in China. The aim of our study is to determine whether patient care is compliant with national clinical pathways in public general hospitals of Pudong New Area in Shanghai.
  
  
  METHODS
  We identified the clinical pathways established by the National Health and Family Planning Commission of China for 5 common conditions (community-acquired pneumonia, acute myocardial infarction (AMI), heart failure, cesarean section, type-2 diabetes). We randomly selected patients with each condition admitted to one of 7 public general hospitals in Pudong New Area in China in January, 2013. We identified key process indicators (KPIs) for each pathway and, based on chart review for each patient, determined whether the patient's care was compliant for each indicator. We calculated the proportion of care which was compliant with clinical pathways for each indicator, the average proportion of indicators that were met for each patient, and the proportion of patients whose care was compliant for all measures. For selected indicators, we compared compliance rates among hospitals in our study with those from other countries.
  
  
  RESULTS
  Average compliance rates across the KPIs for each condition ranged from 61 % for AMI to 89 % for pneumonia. The percent of patient receiving fully compliant care ranged from 0 for AMI and heart failure to 39 % for pneumonia. Compared to the compliance rate for process indicators in the hospitals of other countries, some rates in the hospitals that we audited were higher, but some were lower.
  
  
  CONCLUSIONS
  Few patients received care that complied with all the pathways for each condition. The reasons for low compliance with national clinical pathways and how to improve clinical quality in public hospitals of China need to be further explored.
authors.affiliation: Department of Hospital Management, Key Laboratory of Health Technology Assessment (MOH), Collaborative Innovation Center of Social Risks Governance in Health, School of Public Health, Fudan University, No 138, Yi Xue Yuan Road, P.O.Box 197, Shanghai, 200032, P. R. China. 11111020022@fudan.edu.cn.
authors.forename: Xiao Yan
authors.initials: XY
authors.lastname: He
authors.affiliation: School of Medicine, Stanford University, HRP Redwood Building, 259 Campus Drive, Stanford, CA, 94305-5405, USA. bundorf@stanford.edu.
authors.forename: M Kate
authors.initials: MK
authors.lastname: Bundorf
authors.affiliation: Commission of Health and Family Planning of Pudong New Area, No. 990, Chengshan Road, Shanghai, 200125, P. R. China. gjj2228@sina.com.
authors.forename: Jian Jun
authors.initials: JJ
authors.lastname: Gu
authors.affiliation: Department of Hospital Management, Key Laboratory of Health Technology Assessment (MOH), Collaborative Innovation Center of Social Risks Governance in Health, School of Public Health, Fudan University, No 138, Yi Xue Yuan Road, P.O.Box 197, Shanghai, 200032, P. R. China. zhouping@fudan.edu.cn.
authors.forename: Ping
authors.initials: P
authors.lastname: Zhou
authors.affiliation: Department of Hospital Management, Key Laboratory of Health Technology Assessment (MOH), Collaborative Innovation Center of Social Risks Governance in Health, School of Public Health, Fudan University, No 138, Yi Xue Yuan Road, P.O.Box 197, Shanghai, 200032, P. R. China. xuedi@shmu.edu.cn.
authors.forename: Di
authors.initials: D
authors.lastname: Xue
mesh_terms: D002681:China; D019091:Critical Pathways; D005260:Female; D019983:Guideline Adherence; D006333:Heart Failure; D006760:Hospitalization; D006769:Hospitals, General; D006779:Hospitals, Public; D006801:Humans; D007297:Inpatients; D008297:Male; D008485:Medical Audit; D009203:Myocardial Infarction; D011014:Pneumonia; D017410:Practice Guidelines as Topic; D019984:Quality Indicators, Health Care