临床路径管理模式控制开放与腹腔镜下腹股沟疝无张力修补术的成本-效果分析  

Cost-effectiveness analysis of clinical path management in laparoscopic and open inguinal hernia repair

作　　者：林璐[1] 柏金喜[1] 王惠春[2,3] 周致园[2,3] 赵汝成[1] 汤睿[2,3] 顾岩[2,3] 

机构地区：[1]上海交通大学医学院附属第九人民医院信息科病史室,上海200011 [2]上海交通大学疝与腹壁外科疾病诊治中心 [3]上海交通大学医学院附属第九人民医院普外科

出　　处：《中华疝和腹壁外科杂志（电子版）》2013年第1期11-15,共5页Chinese Journal of Hernia and Abdominal Wall Surgery(Electronic Edition)

基　　金：上海市级医院适宜技术联合开发推广应用基金资助项目(SHDC12010204)

摘　　要：目的研究临床路径管理模式应用于开放和腹腔镜下腹股沟疝修补术对控制腹股沟疝患者医疗成本和效果的影响。方法对2011年1月1日至2011年12月31日出院的腹股沟疝患者按是否进入临床路径分为临床路径组(173例)与非临床路径组(192例),使用成本-效果分析(cost-effectiveness analysis,CEA)方法研究临床路径管理模式控制开放与腹腔镜下腹股沟疝无张力修补术的医疗成本构成、社会成本消耗和成本-效果增量。结果无论开放或腹腔镜手术,临床路径组患者住院天数、直接医疗成本、直接非医疗成本、间接成本和总成本均显著低于非临床路径组(P<0.05)。成本-效果分析表明临床路径组采用开放与腹腔镜手术,腹股沟疝患者每减少1例复发需要消耗的社会成本分别为6313.72元与9164.00元,分别较非临床路径组降低18.60%和19.20%;每避免1例术后并发症需要消耗社会成本分别为6498.03元与9305.44元,较非临床路径组降低19.58%和21.57%。结论使用临床路径管理模式能够显著降低腹股沟疝患者住院医疗成本,优化成本构成,减少社会成本消耗,提高医疗质量。Objective To analyze the application of clinical pathway management utilized in laparoscopie inguinal hernia, open mesh repair in control costs and effectiveness. Methods Based on the application of clinical pathway, the patients with inguinal hernia who discharged from Jan. 1,2010 to Dec. 31,2010, were classified into the clinical group （173 patients） and non-clinical group （192 patients）. Cost-effectiveness analysis （CEA） was used to analyze the medical costs structure,expenses of social costs and cost-effectiveness ratio using clinical pathway management in laparoscopic inguinal hernia and open mesh repair. Results Hospital stay, direct and indirect medical costs and total costs of clinical group were significant less than non-clinical group （P 〈 0.05）. Cost-effectiveness analysis showed that the social costs for the patients with inguinal hernia in clinical group to prevent relapse were 6 313.72 RMB for non-laparoscopic surgery and 9 164.00 RMB for laparoscopic surgery, 18.60% and 19.20% less than non-clinical group ;The social costs for the patients in clinical group to prevent postoperative complications were 6 498.03 RMB for non-laparoscopic surgery and 9 305.44 RMB for laparoscopic surgery, 19.58% and 21.57% less than non-clinical group. Conclusions Clinical pathway management significantly decreases the medical and social costs, opti- mizes the cost structure and improves the quality of medical care.

关 键 词：疝 腹股沟 临床路径 成本-效果 

分 类 号：R656.2[医药卫生—外科学]