抗菌药物临床应用精细化专科管理  

Refined special management of clinical use of antibiotics

作　　者：张乐辉[1] 孟黎辉[2] 高月[1] 佟朝霞[3] 陈颖[1] 

机构地区：[1]首都医科大学附属北京安贞医院医疗保险办公室,北京100029 [2]首都医科大学附属北京安贞医院医院感染管理办公室,北京100029 [3]首都医科大学附属北京安贞医院医务处,北京100029

出　　处：《中华医院感染学杂志》2014年第24期6105-6106,6109,共3页Chinese Journal of Nosocomiology

基　　金：首都医科大学基础-临床科研合作基金资助项目(14JL57)

摘　　要：目的对临床实行抗菌药物临床应用的精细化专科管理,为临床治疗提供参考依据。方法使用按疾病诊断相关分组(Diagnosis Related Groups,DRGs)技术评价抗菌药物临床应用,应用数学模型技术实现抗菌药物使用实时监测,并对循环系统疾病诊治中抗菌药物应用特点进行探讨。结果某科室的5个DRGs病组抗菌药物平均费用均高于标准水平;抗菌药物使用强度前10位的品种中有8种为口服抗菌药物;感染性疾病治疗为主的科室(如呼吸科)抗菌药物使用强度较大,手术科室抗菌药物使用强度较非手术科室大,以Ⅱ类切口手术为主的科室抗菌药物使用强度较以Ⅰ类切口手术为主的科室大;同科室、同级别医师经治的患者抗菌药物使用率以及抗菌药物使用强度比较有差异,提示需要关注临床医师抗菌药物的应用。结论引入DRGs技术,实行抗菌药物临床应用的精细化专科管理,达到了预期的效果,也建立了持续改进的机制。OBJECTIVE To carry out the refined special management of clinical use of antibiotics so as to provide guidance for the clinical treatment .METHODS The clinical use of antibiotics was evaluated by using the diagnostic related groups （DRGs） ,the real‐time monitoring was achieved by means of mathematical modeling techniques , and the characteristics of use of antibiotics for treatment of circulatory system diseases were observed .RESULTS The average cost of antibiotics of the 5 DRGs case groups of a cardiosurgery department was higher than the standard level .Of the antibiotics ranking the top 10 use intensity ,8 were the oral administration antibiotics .The intensity of use of antibiotics was greatest in the departments dominating the treatment of infectious diseases such as the respiratory department ;the intensity of use of antibiotics was greater in the operating department than in the non‐operating departments ;the intensity of use of antibiotics was greater in the department dominating the type Ⅱ incision surgery than in the departments dominating the type Ⅰ incision surgery .The same‐level physi‐cians in the same department varied in the utilization rate of antibiotics or the intensity of use of antibiotics ,indica‐ting that the clinical physicians should focus on the use of antibiotics .CONCLUSION The expected effect has been achieved ,and the continuous improvement mechanism has been established through the refined special manage‐ment of clinical use of antibiotics based on the DRGs techniques .

关 键 词：抗菌药物 使用强度 按疾病诊断相关分组 实时监测 

分 类 号：R978.1[医药卫生—药品]