基于单病种全程管理的鼻咽癌新型临床路径的研发与实践  

A New Model of Clinical Pathway for Comprehensive Management of Nasopharyngeal Carcinoma:Research and Clinical Practice

作　　者：李济时[1] 徐志渊[1] 陈志坚[1] 徐小平[2] 景海曼[1] 周略[1] 陈仙[1] 林嘉安 李咏梅[1] 

机构地区：[1]香港大学深圳医院临床肿瘤中心,广东深圳518000 [2]香港大学深圳医院医疗事务部,广东深圳518000

出　　处：《中国肿瘤》2017年第2期106-110,共5页China Cancer

基　　金：深圳市科创委基础研究项目(JCYJ20140414092023248)

摘　　要：[目的]基于单病种全程管理的理念研发鼻咽癌新型临床路径,以促进鼻咽癌的规范化诊断与治疗。[方法]以本中心鼻咽癌诊疗规范为基础设计诊疗全程的临床路径,将符合入径病例纳入路径管理,预期目标入路径率(适合入路径者/符合入路径者)≥50%;完成路径率(完成路径者/入路径者)≥70%;非预见内的变异率(非预见内的变异/入路径者)<10%。[结果 ]自2015年1月1日至12月31日,共收治39例新确诊鼻咽癌患者,36例符合入路径标准,100%(36/36)进入路径。完成路径率97.2%(35/36),变异率8.3%(3/36)。诊断与分期阶段、诱导化疗阶段(共3周期)、单纯放疗、同期放化疗阶段平均住院日分别为0.8、8.2、0、18.7d。单纯放疗产生的平均费用为(83 564±77)元,同期放化疗为(109 316±15 050)元,诱导化疗+同期放化疗的治疗模式产生的平均费用为(118 744±11 341)元。[结论]较高的入路径率、较高的完成路径率、较低的变异率体现了基于单病种全程管理的鼻咽癌新型临床路径有效可行,值得进一步推广应用。[Purpose] To develop a new model of clinical pathway for comprehensive management of nasopharyngeal carcinoma（NPC）,and to promote the standardization of diagnosis and treatment algorithms of NPC.[Methods] The clinical pathway was modified from the NPC protocol of the Clinical Oncology Center of the University of Hongkong—Shenzhen Hospital（HKU-SZH） and enrolled all indicated NPC patients for comprehensive management. The target enrollment ratio（patients enrolled into the pathway/patients eligible for the pathway） was more than 50%;the target completion rate（patients completed the whole pathway/patients enrolled） was more than 70%;the target rate of variation（cases of unintended variation/cases enrolled） was less than 10%. [Results] From 1st January to 31st December 2015,there were 39 cases of newly diagnosed NPC in the Clinical Oncology Center of HKU-SZH. Thirty-six of them were eligible for the clinical pathway and 100%（36/36） were enrolled. The completion rate was 97.2%（35/36） with 8.3%（3/36） of variation. Duration of hospitalization in different phases of staging workup,neoadjuvant chemotherapy（total 3 cycles）,radiotherapy（RT） alone,concurrent chemo radiotherapy（CCRT） were 0.8,8.2,0, 18.7 days,respectively. The average cost（Yuan,RMB） for RT alone,CCRT,Neoadjuvant chemotherapy combined with CCRT were 83 564±77,109 316 ±15 050,118 744 ± 11 341,respectively.[Conclusions] The excellent enrollment rate,high completion rate and low variation rate illustrates feasibility of this new model of clinical pathway for comprehensive management of NPC,which deserves further nation-wide evaluation and application.

关 键 词：临床路径 鼻咽癌 单病种管理 

分 类 号：R739.63[医药卫生—肿瘤]