临床路径试点工作推广中的问题、成因与对策研究  

Problems,Causes and Countermeasures in Promotion of the Clinical Pathway Pilot Project

作　　者：张莹[1] 赵琨[2] 齐雪然[2] 马莉[1] 邵静[1] 刘嘉[1] 

机构地区：[1]大连医科大学公共卫生学院,辽宁省大连市116044 [2]卫生部卫生发展研究中心

出　　处：《中国全科医学》2013年第10期1160-1162,共3页Chinese General Practice

基　　金：卫生部临床路径管理试点工作第三方评估课题(01141)

摘　　要：目的探讨影响医务人员积极开展临床路径工作的主要因素,提出今后完善临床路径管理工作的对策与建议。方法根据全国110家临床路径试点医院的基线调查结果,采用目的抽样法,抽取县二级医院、市级三甲医院、省教学三甲医院各一所作为访谈机构,对相关人员进行访谈。应用Giorgi,A.(1995)的四步主题性分析法对整理后录音和文字资料进行定性分析。结果个别医师对临床路径管理的认识不够全面,对实施临床路径的目的认识不清。影响医务人员积极开展临床路径的主要因素是医院领导的能力与个人素养,医院内部管理体系与院领导的重视程度,医保支付方式,医院床位使用率,路径文本的制定和信息系统,以及医院的激励机制和科室间的合作。结论临床路径试点工作取得了很大的成效,但依然存在一些问题。应建立国家层面的宏观医疗卫生服务战略,与其他部门协同制定相应的配套措施,确保各方利益平衡。Objective To investigate the main factors influencing the medical staff to actively carry out clinical path- ways so as to put forward countermeasures and suggestions for better practice in future. Methods According to the results of base-line survey of 110 pilot hospitals in China, purpose sampling was taken to choose one hospital from each of county - leveled, municipal - leveled and provincial - leveled hospitals. The relevant personnel in the selected hospitals were interviewed, and then the data collected from the medical staff were qualitatively analyzed by using Giorgi, A＇s four - step thematic analysis （1995） . Results Some individual doctors could not completely understood the clinical pathway management and failed to recognize the ob- jective to implement clinical pathway. The major factors that impede full participation of medical staff in clinical pathway were the power of hospital leaders and their personal quality, internal management mechanism of hospitals, appreciation from hospital leaders, payment model of medical insurance, occupancy rate hospital beds, formulation of path - text, set - up of information system, mechanism of hospital incentives, and cooperation between individual departments. Conclusion The overall clinical pathway management pilot work has got good effect, nevertheless some problems still exist. The national - leveled strategy of the health services should be established, and the corresponding supporting measures needs to be formulated through coordination among departments to ensure the balance of interests of all parties.

关 键 词：临床路径管理 影响因素 定性研究 

分 类 号：R197.1[医药卫生—卫生事业管理]