临床路径管理实施效果分析  

The Effect of Clinical Pathway Management

作　　者：王彬翀[1] 陈欣[1] 左煌[1] 李红霞[1] 

机构地区：[1]西安交通大学医学院第一附属医院,陕西西安710061

出　　处：《中国卫生质量管理》2013年第4期26-28,共3页Chinese Health Quality Management

摘　　要：目的评价实施临床路径管理对医疗质量的影响。方法将2012年实施临床路径管理的结节性甲状腺肿(单侧)、老年性白内障(单眼)和腹股沟疝(单侧)3个病种共计977例出院患者作为路径组,将2010年未实施临床路径管理的相同治疗方式的3个相同病种1 043例出院患者作为对照组,对两组相同病种进行比较;选择老年性白内障路径组124例变异病例进行变异分析。结果 3个病种实施临床路径管理后,平均住院日、平均住院费用和住院药费占比3项评价指标较未实施时呈不同程度降低;患者满意度较前提高;腹股沟疝和结节性甲状腺肿2个病种的抗菌药物合理应用各项指标有明显提高,各指标差异均有统计学意义(P<0.05);老年性白内障路径组发生变异的主要原因是合并其它疾病、患者双眼手术和部门休假致延迟。结论临床路径管理能有效缩短平均住院日,控制医疗费用的增长,提高患者满意度,促进合理用药;对变异发生情况进行分析,采取改进措施,可实现医疗质量的持续改进。Objective To evaluate the effect of clinical pathway management on medical quality. Method A total of 977 patients discharged with nodular goiter （unilateral） , senile cataract （monocular） or inguinal hernia （unilateral） in 2012 who were under clinical pathway management were recruited as pathway group, and 1043 patients of the same disease without clinical pathway management in 2010 were selected as a control group. The two groups were compared based on the diseases. The varia- tion analysis was performed in 124 patients with senile cataract pathway management. Result After implementation of clinical path management in the three diseases, the average length of stay, the average cost of hospitalization and hospital drugs cost pro- portion were reduced; and the patient satisfaction increased. The indicators on rational use of antibiotics in inguinal hernia and nodular goiter had significantly improved with statistically significant differences （ P 〈 0.05 }. The variation in senile cataract path- way was mainly due to combination with other diseases, both eyes surgery and delay caused by departmental leave. Conclusion The clinical path management can effectively shorten the average length of stay, control the growth of health care cost, improve patient satisfaction, and promote rational use of medicines. The analysis of variation and taking countermeasures enables the hos- pital＇scontinuous quality improvement.

关 键 词：临床路径 合理用药 医疗质量 

分 类 号：R197.323[医药卫生—卫生事业管理]