基于德尔菲法的临床路径管理评价指标体系研究  

Delphi research on the evaluation indicators system for clinical pathway management

作　　者：夏萍[1] 吴大嵘[1] 黄雪莹[2] 程兰[1] 林振伟[3] 张伟旋[1] 蔡坚雄[1] 

机构地区：[1]广东省中医院,广州510120 [2]广州医学院第二附属医院 [3]广州中医药大学经济与管理学院

出　　处：《中华医院管理杂志》2012年第11期811-817,共7页Chinese Journal of Hospital Administration

基　　金：基金项目：中国医院协会2009-2010年度医院管理研究课题（CHA-3-2010-036）;2007年度国家中医药行业科研专项（200707004）

摘　　要：目的从路径管理控制的角度构建临床路径管理评价指标体系。方法在循证评价、专题小组讨论及医护人员对指标重要性进行评价的基础上，拟定指标体系草案。遴选全国60名专业人士组成多学科专家组，采用德尔菲法对草案进行三轮咨询。采用层次分析法确定指标权重，采用积极系数、权威程度、协调程度检验专家咨询的可靠性。结果三轮问卷回收率分别是85％、70％、94％；专家权威系数为0．80；变异系数随着咨询次数增加而减小，协调系数波动在0．40～0．83之间。三轮咨询后，专家意见趋于集中，临床路径管理评价指标体系包涵3个一级指标，9个二级指标，36个三级指标。结论专家意见协调程度高，结果可取，所构建的临床路径管理指标体系可作为临床路径规范化管理和持续改进的评价工具。Objective To build the indicators system for clinical pathway management as required by clinical pathway control. Methods An indicators system was proposed by means of evidence-based review, focus group discussions, and ratings of the indicators importance by doctors and nurses. A multidisciplinary panel of 60 experts from across the country were selected. A 3-round Delphi survey was made on the proposed indicators. The weights of the indicators were established by analytical hierarchy process （AHP）. The response rate, Cronbach＇s a, and the authority coefficient of experts were used as a measure of reliability. Results The response rates of the 3 rounds were 85%, 70%, and 94% the experts authority coefficient was 0. 80. The ccoefficient of variation fails with the rising number of consultations. The Kendall＇s W ranged from 0. 40 to 0. 83. Following the 3 rounds, consensus was achieved among experts as such a system comprising three first-level, 9 second-level, and 36 third-level indicators. Conclusion The expert consultation has achieved reliable results. The established indicators system can serve as a useful instrument for standardized development of clinical pathways management and constant improvement.

关 键 词：临床路径 评价指标体系 德尔菲法 层次分析法 肯德尔和谐系数 

分 类 号：R197.3[医药卫生—卫生事业管理]