江西基层医疗机构实施临床路径管理之效果和意义  

Implementation of clinical pathway management in primary health care institutions:results and significance

作　　者：王素珍[1] 贾立明[2] 陈和利[1] 廖立华[2] 郑先平[1] 刘霞[1] 卢恬[2] 王力[1] 江乐盛[1] 利家平[2] 

机构地区：[1]江西中医药大学经济与管理学院,江西南昌330004 [2]江西省卫生厅药政处,江西南昌330046

出　　处：《中国农村卫生事业管理》2013年第9期968-971,共4页Chinese Rural Health Service Administration

基　　金：国家自然科学基金项目"农村基本药物流通安全监管研究--以江西为例"(71063011);江西省社科基金重点项目"基于基本药物制度视角的江西基本诊疗路径管理机制研究"(12GL02);卫生部药政司项目"基层医疗机构基本诊疗路径研究"

摘　　要：目的:进一步明确基层医疗机构实施临床路径管理的效果和实际意义。方法:对江西省基层医疗机构实施的24种常见病、多发病的临床路径试点情况进行数据采集,录入Excel(2007)进行逻辑检验,并对符合逻辑的数据进行统计学的频数分析和相关分析。结果:全省226家基层医疗卫生机构累计完成入径病例8 428例,完成路径病例7 856例,让24个试点病种患者得到了全程精细化管理治疗,住院天数降低显著,治疗费用下降明显,治愈率和满意度提高。实施临床路径后住院病人的住院天数下降均超过10%。下降率>30%的共有11种病,占此次施行24个病种的45.83%;下降率20%～30%,有9种病,占37.5%;下降率20%～10%的有4个病种。治疗费用下降率大于40%的病种有5个,治疗费用下降了20%～40%的病种有5个,占24种病种的20.83%;治疗费用下降了10%～20%的病种有12种,占50%。医疗机构问卷调查显示在进行诊疗路径管理的机构,诊疗行为更加规范、合理的机构占95.48%;医疗纠纷减少的医疗机构占77.40%;治愈率上升的医疗机构占79.10%;患者满意度提高的医疗机构占84.75%。结论:基层医疗机构实施临床路径管理,医疗供需双方都得到实惠。对规范医疗行为、科学合理确定看病费用、促进双向转诊机制构建、新农合医疗费用支付方式的改革、医务人员医疗水平提升等提供了丰富的实证参考。建议在全国基层开展临床路径试点工作,不断总结和推广,解决广大群众看病难和看病贵。Objective To define the effect and practical significance of implementing clinical pathway management in primary health care institutions. Methods Data were collected on pilot work of clinical pathway management of 24 kinds of common diseases conducted by primary health care institutions in Jiangxi province. Logical inspections were made when data were recorded in Excel （2007） and then statistic analysis was made. Results Among the 226 primary health care institutions there was a total of 8428 cases,of which 7856 cases achieved pathway management. Patients of the 24 kinds of diseases got the fine management treatment,whose hospitalization stay and treatment costs reduced significant- ly. The cure rate and satisfaction greatly improved. Conclusions After the implementation of clinical pathway manage- ment in primary health care institutions, medical supply and demand both benefit from it, which provides reference for regulating medical behavior, determining scientific and rational medical expenses, promoting the two--way referral mechanism, payment reform of the new rural medical care scheme,and improvement in diagnosis and treatment capacity of medical personnel. It is proposed that pilot project of clinical pathway management be launched nationally in primary health care institutions, the results of which will be summarized and promoted to solve the problem of difficulties in see- ing a doctor and high medical expenses.

关 键 词：临床路径 基层医疗机构 效果 意义 

分 类 号：R197.3[医药卫生—卫生事业管理]