基于故障树映射的单病种临床路径制定  

Development of Clinical Pathway Based on Fault Tree Mapping

作　　者：闫雨蒙 刘子先[1] 梁丽军 YAN Yu-meng;LIU Zi-xian;LIANG Li-jun(College of Management and Economics,Tianjin University,Tianjin 300072,China;School of Management,Tianjin University of Traditional Chinese Medicine,Tianjin 301617,China)

机构地区：[1]天津大学管理与经济学部,天津300072 [2]天津中医药大学管理学院,天津301617

出　　处：《工业工程与管理》2019年第6期188-194,共7页Industrial Engineering and Management

基　　金：天津市哲学社会科学规划研究项目(TJGL16-013Q)

摘　　要：现有的临床路径制定方法柔性不足,没有考虑后续路径实施时医疗机构或患者对控制医疗成本与医疗风险的异质性需求,为了弥补该缺陷,提出了一种基于故障树映射的单病种临床路径制定方法。以市场对医疗风险与医疗成本的控制需求为导向,从正常服务生命周期的逆向出发,构建不良事件故障树并利用可靠性映射模型生成符合预期可靠性与成本目标的可行性临床路径,实现治疗方案配置、医疗风险、医疗成本的有机集成。最后,以病种-胫骨平台骨折为例证明该方法对制定临床路径具有重要参考价值,辅助患者和医师根据实际需求做出合理选择。The existing method of developing clinical pathway is not flexible enough,and fails to consider the medical institutions′ or patients′ heterogeneity requirement of controlling medical costs and medical risks.To make up for this defect,a method for developing clinical pathway based on fault tree mapping was proposed.Guided by the market demand for medical risks and medical costs,a fault tree of adverse events was constructed.Then a feasible clinical pathway that met the expected reliability and cost targets was created with the reliability mapping model,integrating treatment plans configuration,medical risk with medical cost.Finally,the instance of the diagnosis-related group-tibial plateau fractures proved that the method had important reference value for developing the clinical pathway,and assisted the patient and the physician to make reasonable choices according to the actual demands.

关 键 词：临床路径 故障树分析 逆向搜索 

分 类 号：C93[经济管理—管理学] N94[自然科学总论—系统科学]