• Quality Improvement in Health Care
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• v.9 no.1
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• pp.66-73
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• 2002

The current health care system demands provisions for patient care in perspectives of a cost-effectiveness and patient satisfaction. Critical pathway implementation facilitates optimal sequencing and intervention timing of patient care, and makes medical team and patients participate in a treatment actively. In this study, a critical pathway was developed and implemented to patients with osmidrosis who undertake operation. Sixty patients were included in the study. The critical pathway was implemented for care of 26 patients while the traditional care was implemented for 34 patients. In the critical pathway implemented group, time needed for charting and unessential working was reduced. Mean time amount of time for patient nursing was increased. The critical pathway implementation is an effective method to utilize time of medical team. Also it increases the satisfaction index of patients and medical team simultaneously.

• Quality Improvement in Health Care
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• v.7 no.2
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• pp.156-167
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• 2000

Background: Emphasis in healthcare during the 1990s has been to provide both optimal wellness and function with quality in a Cost-effective manner. Critical pathway was developed to meet the need to guide clients along the continunm of care and to achieve continuity of care. The purpose of this study is to review and analyze articles related to the critical pathway that had developed and applied in Korea and abroad from 1995 to 1999. Methods: Total 39 studies were analyzed in terms of group of application, need of development, horizontal axis: time frame, vertical axis : items of care, task force team, identification of preliminary critical pathway, validation of preliminary critical pathway, types of final critical pathway, a person who coordinates and effects on critical pathway. Results: In the aspect of group of application, there were various diseases in the overseas than in Korea. In domestic and overseas, the horizontal axis included mainly the time from the start of hospitalization to discharge and vertical axis of the critical pathway included commonly the following nine items : tests, diet, medications, consultations, activity, assessments, treatments, education, discharge planning. Preliminary critical pathway was mainly drawn up through chart review in both. Types of final critical pathway were mostly for medical team use in Korea and were for medical team and patient use in abroad. A person who coordinates critical pathway was mostly nurse in abroad. There was positive effects on critical pathway in both. Conclusion: Staff education and information about critical pathway are needed to use it effectively.

• Quality Improvement in Health Care
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• v.18 no.1
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• pp.37-55
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• 2012

Objectives : This study was conducted to evaluate the effect of fixed critical pathway with emr (electronic medical record) on the length of hospital stay, the cost and quality of care provided to gastrectomy patients in a university hospital and to develop flexible critical pathway with emr which can be used excluded or drop-out patients. Methods : Thirty-eight patients with gastrectomy were included as case group and Thirty-four patients included as control group. The comparison between control and case with using fixed critical pathway were done. To develop and to evaluate usefulness of flexible critical pathway with flexible data base, simulation was done for flexible critical pathway with drop-out patients. Result : The major results of this study were as follows: There were no significant differences in patient clinical conditions and no sign of deterioration of quality from critical pathway. The length of hospital stay was 11 days in control group, 8 days in path group(P<0.01). The total costs during the hospital stay were reduced in path group. However the cost per day was significantly increased from reduction of hospital stay(554,352 won in control, 645,669 won in path group). One hundred percentage of drop out patients(60) in the simulation of flexible critical pathway was successful. Conclusion : Computerized critical pathway reduced the length of hospital stay, total hospital costs and resource utilization without harming quality of patient care. The flexible critical pathway program can be used as one of the powerful management tools for reducing the practice variations and increasing the efficiency of care process and decreasing the workload of doctors and nurses in Korean hospital settings.

• Health Policy and Management
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• v.2 no.1
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• pp.115-147
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• 1992

The purposes of this paper are twofold : to identify what pathway insured patients are seeking medical care services through, and then, to provide the basis for the prediction and evaluation of the effects of a new policy intervention. To change the patient flow across different types of medical care facilities, this intervention has been enforced since July 1, 1989. It is mainly aimed at discouraging the use of the tertiary hospitals by imposing some restrictions on the patient's choice. The data for analysis were obtained from the claims to the insurance for govermment and school employees. The sample was drawn from the claims for about 1% of the enrollees using medical care facilities during 2 years since January 1, 1985. The sample included 91, 483 for 1985 and 81,914 for 1986, among them the number of patients to initiate the use of medical care service were 66,757 and 59,498 respectively. This paper analysed what types of and how many medical care facilities the patient with same disease had used.

• Journal of Korean Academy of Nursing Administration
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• v.6 no.2
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• pp.211-225
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• 2000

With the drastically changing healthcare market, the adoption of DRG system and the use of Critical Pathway will be increased gradually in order to care hospitalized patients qualitatively and manage cost-effectively in Korea. The purpose of this quasi-experimental research is to apply and analyze the developed critical pathway to the patients with Cesarean section. 35 eligible subjects for the control group were chosen from postpartum patients who has delivered at H-hospital in Kwang-ju, and were questioned after appling previous care plan from May to December, 1998. For the experimental group, 37 subjects were chosen and questioned after applying Critical Pathway service from January to June, 1999. The instruments are a critical pathway for the patients with Cesarean section developed by chung(1998) and a questionnaire that evaluate patients and family members' satisfaction level. Also, educational materials were used to inform them in the process of Critical Pathway application. As a result of chi-square test on general characteristics, there is significant difference between control group and experimental group only in terms of room size(p= .010). There are no significant differences in the average length of stay in the hospital between control group and experimental group(t=.078). Also, the average medical consult fee has no difference significantly between two groups(t= .105). The findings showed that the experimental group with critical pathway service scored significantly higher than control group on the satisfaction level toward care services(p=.000). The items are post-operative care, postpartum exercise technique, breast feeding and breast manage through educational materials. In conclusion, the research indicates that the application of planned Critical Pathway can have a positive impact on satisfaction level of inpatients with Cesarian section.

• Quality Improvement in Health Care
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• v.6 no.1_2
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• pp.6-11
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• 1999

• Quality Improvement in Health Care
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• v.6 no.1_2
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• pp.12-17
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• 1999

• Quality Improvement in Health Care
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• v.6 no.1_2
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• pp.32-36
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• 1999

• Journal of Korean Academy of Fundamentals of Nursing
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• v.7 no.2
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• pp.149-163
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• 2000

The purposes of this study were to investigate the pathway which stroke patients take in seeking medical care and to identify factors which influence that pathway. This study was conducted by a survey. The subjects were 130 adults, who were diagnosed with a stroke between January and April of 2000. Data was collected by means of a interview, questionnaires, and an Activity Index. The result of this study are summarized as follows: 1. The mean age of subject was 61.58 years. Forty-nine percent were men and fifty percent were women. The majority of the subjects were married. For educational level, thirty-three percent finished elementary school, and twenty-three percent, high school. Most of the subjects reported 'middle' economic status. Ninety-two percent lived with their spouse and children. The diagnosis for seventy-two percent was ischemic stroke and for twenty-two percent, hemorrhagic stroke. 2 The most frequent early sign of stroke was hemiplegia(43.3%), loss of consciousness (36.7%), dysarthria(33.3%). The type of hospital first used was a herb hospital(40.8%), or a western hospital(59.2%). The factors in their choice were ; distance from the hospital to the place that the stroke occurred(47.5%), desire for a herb hospital(15.8%), and an invitation(12.9%). The ischemic stroke patients preferred herb hospitals, but hemorrhagic stroke patients preferred a western hospitals. 3. The pattern of stroke patients seeking medical care was that forty-three percent of stroke patients pass through step 1, forty-six percent, through step 2, and 8.5% through step 3. The more steps, the higher the use of herb hospitals. 4. The factors influencing the pathway of stroke patients seeking medical care were diagnosis, and level of consciousness. Ischemic stroke patients used herb hospitals, more frequently hemorrhagic stroke patients, who used western hospitals. The alert patient preferred a herb hospital, but stupor patients preferred a western hospital. 5. The Activity Index was not related to the pathway which stroke patients used in seeking medical care.

• Research in Community and Public Health Nursing
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• v.12 no.2
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• pp.329-337
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• 2001

Purpose: This study was to develop a critical pathway for COPD clients in home health care. Method: Review of literature. Analysis of 10 cases of home health records of COPD clients without other major chronic illness, and Contents validity test Results 1. Vertical axis(l4 activities) physical and mental assessment, family assessment. environment assessment, rights and duties of client, oxygen use and safety, education of disease process and symptom, medication, nutrition and elimination, tests, activities, respiratory exercise, sleeping pattern. consultations and discharge planning. 2. Horizontal axis was set by the number of visits(average number of visits is 6.4) and vertical axis was set with 14 activities and the contents which should have occurred, according to the time frames of the horizontal axis. 3. According to the contents validity test, among the total of 234 items, 176 items showed over 83% agreement and 58 items showed less than 83% agreement. Those items with less than 83% agreements were either deleted or revised. Conclusion this critical pathway is applicable to the home health care of COPD clients to provide quality home nursing care services at lower cost.