临床路径管理对急性冠脉综合征住院患者医疗质量的影响  

Influence of Clinical Pathway Management on Medical Quality for Inpatients with Acute Coronary Syndrome

作　　者：杨建伟[1] 陆剑嵘[1] 宋培新[1] 王涟[1] 王静[1] 徐标[1] YANG Jian-wei LU Jian-rong SONG Pei-xin WANG Lian WANG Jing XU Biao(Nanjing Drum Tower Hospital of Nanjing University Medical School, Nanjing 210008, China)

机构地区：[1]南京大学医学院附属鼓楼医院,南京市210008

出　　处：《现代医院管理》2017年第2期45-47,共3页Modern Hospital Management

摘　　要：目的比较急性冠脉综合征(ACS)患者采用临床路径管理前后,医疗质量和住院费用的变化。方法收集在我院住院的ACS患者数据,统计行临床路径管理前2年和后2年住院过程中药物的使用率,按照危险度评分及时行早期介入干预的百分率,住院过程中的病死率以及平均住院费用和平均住院日。结果实行临床路径管理后平均路径率84.2%,平均变异率14.1%。和实施前比较,ACS住院患者他汀、ACEI、β-受体阻断剂、双联抗血小板药物使用率均明显提高(P<0.01);早期及时的冠脉急诊介入干预率明显提高(分别为85.2%和42.1%,P<0.01),扣除物价下调等因素,平均住院费用降低8.5%。平均住院日降低0.5d。平均住院死亡率也明显降低。结论实施临床路径管理,可以使ACS住院患者接受更规范的药物治疗,更好的早期介入干预,降低平均住院费用和平均住院日,也有降低住院死亡率的作用。Objective：To compare the patients with acute coronary syndromes before and alter clinical pathway practice,the changes in medical quality and hospitalization expenses. Method：The authors collected the data on ACS patients and made statistical record：the drug utilization rates ,the rates of early percutaneous coronary intervention（ PCI ）, mortality in hospitalization, the average hospitalization expenses and the average hospitalization days 2 years before and after the implementation of clinical pathway. Result ： After the implementation, the average rate of clinical pathway is 84.2% ,and the average aberration rate is 14. 1%. In comparison, the using rates of statins,ACEI, bern-receptor blocker and DAPT increase significantly （ P 〈 0. 01 ） ~ the early and timely coronary inter- vention increases remarkably（ 85.2% and 42. 1% respectively, P 〈 0.01 ） ; the average hospitalization expense decreases excluding the factors of price cut：the average hospitalization is shortened to 0. 5 days and the average mortality in hospitalization decreases ob- viously. Conclusion：Clinical pathway implementation encourages inpatients to more standardized drug therapy,better early intervention so to decrease the average hospitalization expense and the average hospitalization days,and reduce hospitalization mortality.

关 键 词：临床路径 急性冠脉综合征 住院管理 医疗质量 

分 类 号：R197[医药卫生—卫生事业管理]