Journal of Capital Medical University ›› 2023, Vol. 44 ›› Issue (1): 35-41.doi: 10.3969/j.issn.1006-7795.2023.01.006

• Clinical Epidemiology and Clinical Trials • Previous Articles     Next Articles

Implementation and related influencing factors of the clinical pathway of acute exacerbation of chronic obstructive pulmonary disease

Wang Yingquan1#, Feng Lin2#, Zuo Yingting2, Tong Zhaohui1, Liang Lirong2*   

  1. 1. Department of Respiratory and Critical Care Medicine, Beijing Institute of Respiratory Medicine and Beijing Chaoyang Hospital, Capital Medical University, Beijing 100020, China;
    2. Department of Clinical Epidemiology, Beijing Institute of Respiratory Medicine and Beijing Chaoyang Hospital, Capital Medical University, Beijing 100020, China
  • Received:2022-10-24 Online:2023-02-21 Published:2023-01-13
  • Contact: *E-mail:llrcruie@163.com
  • Supported by:
    Beijing Municipal Administration of Hospitals Incubating Program(PX2020014),Science and Technology Program of Beijing (Z201100005520028), Beijing Key Specialists in Major Epidemic Prevention and Control.

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Abstract: Objective To investigate the effect and implementation of clinical pathway(CP) for hospitalized patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD) in a tertiary general hospital, analyze the existing problems and propose corresponding suggestions. Methods Patients with primary diagnose of AECOPD were selected from January 1st, 2016 to December 31st, 2021 through the hospital's integrated big data platform. The clinical baseline characteristics, clinical outcomes, and hospitalization costs were compared with each other between those entered CP of AECOPD and those not, and the factors affecting the enter of CP were analyzed with multivariate Logistic regression. Similar analyses were done between those completed CP and those not completed CP implementation. Results A total of 1 817 hospitalized patients with AECOPD were included. Among these cases, 20.7% (377 of 1 817) of them entered CP of AECOPD, and the proportion changed significantly during the study period. Further, 66.0% (249 of 377) of those entered CP of AECOPD completed the CP, and the proportion did not change significantly during the study period. Age and Charlson Comorbidity Index (CCI) ≥ 2 were the independent influencing factors of not entering CP, and comorbidities of respiratory failure, moderate to severe renal disease were the independent influencing factors of not completing CP. Neither entering CP nor completing CP has significant correlation with patients' in-hospital mortality and length of stay. However, the patients who completed the CP had less medical costs than whose who didn't. Conclusion In real world, the proportion of AECOPD patients who entered CP and the proportion of those completed CP in a tertiary general hospital are both relatively low, especially among the elderly and those with severe chronic comorbidities. The entry and exit criteria of the clinical pathway for these patients should be detailed to improve the implementation of the AECOPD clinical pathway.

Key words: acute exacerbation of chronic obstructive pulmonary disease, clinical pathway, hospitalization costs, influencing factor

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