基于DRG和加速康复外科理念的中医骨伤科临床路径制定探讨  

Discussion on Clinical Pathway Formulation in the Department of Orthopaedics and Traumatology of Traditional Chinese Medicine Based on the Concept of DRG and Enhanced Recovery After Surgery

作　　者：黄杰烽[1] 蒋旭宏[1] 孙华琴 姚志韬[1] 丁佳伟 叶文怡 张沈英婕 童培建[1] 华江[1] 张烁[1] HUANG Jiefeng;JIANG Xuhong;SUN Huaqin(The First Affiliated Hospital of Zhejiang Chinese Medical University,Hangzhou(310006),China)

机构地区：[1]浙江中医药大学附属第一医院,杭州310006

出　　处：《浙江中医药大学学报》2020年第8期810-814,共5页Journal of Zhejiang Chinese Medical University

基　　金：浙江省自然科学基金项目(LY20H270012);浙江省中医药科技计划项目(2020ZB090、2020ZQ016、2019ZQ023);浙江省医院可持续发展正大天晴研究项目(2018ZHA-ZDTQ210)。

摘　　要：[目的]探讨基于疾病诊断相关分组(diagnosis related groups,DRG)付费制和加速康复外科(enhanced recovery after surgery,ERAS)理念的中医骨伤科临床路径的制定。[方法]兼顾DRG付费制、ERAS理念和中医特色治疗,从挖掘中医骨伤科优势病种、日间病房建设、长住院时间病例管控、疑难病例管控和新技术新项目开展等五个方面探讨中医骨伤科临床路径的制定。[结果]临床路径是DRG付费制、加速康复外科及中医特色治疗之间的桥梁。基于DRG付费制和ERAS理念的有效中医临床路径,能够在保证患者安全的前提下提高同质化诊疗水平。临床路径通过挖掘中医骨伤科优势病种和疑难病例管控,形成鲜明的学科特色;通过日间病房建设和长住院时间病例管控,以降低平均住院日;同时有效控制病种均次住院费用,并为新技术新项目的开展腾出空间。[结论]中医骨伤科应大力推广实施中医临床路径并不断优化,这既能体现中医特色治疗和ERAS理念,又能应对医保DRG付费制。[Objective]To explore the formulation of clinical pathways in the Department of Orthopaedics and Traumatology of TCM based on diagnosis related groups(DRG)payment system and the concept of enhanced recovery after surgery(ERAS).[Methods]Considering the payment system of DRG,the concept of ERAS and the characteristic treatment of traditional Chinese medicine(TCM),clinical pathways in the Department of Orthopaedics and Traumatology of TCM were discussed from the following five aspects:Exploring therapeutic advantage diseases in Orthopaedics and Traumatology of TCM,the construction of day wards,the control of cases with long stay in hospital,management of difficult cases and the development of new techniques and new projects.[Results]Clinical pathway is the bridge among DRG payment system,ERAS and characteristic treatment of TCM.The effective clinical pathway of TCM is based on DRG payment system and the concept of ERAS can improve the level of homogeneous diagnosis and treatment on the premise of ensuring the safety of patients.The clinical pathway forms distinct disciplinary characteristics by exploring therapeutic advantage diseases and managing difficult cases in Orthopaedics and Traumatology of TCM,to reduce the average length of hospital stay through the construction of day wards and the control of cases with long hospital stay.At the same time,it effectively controls the hospitalization cost per time for different diseases and makes room for the development of new techniques and new projects.[Conclusion]Department of Orthopaedics and Traumatology of TCM should promote and optimize the clinical pathway of TCM.It can not only embody the characteristic treatment of TCM and the concept of ERAS,but also deal with the DRG payment system of medical insurance.

关 键 词：疾病诊断相关分组 医保支付 临床路径 中医骨伤科学 加速康复外科 优势病种 疑难病例 新技术 

分 类 号：R395%[哲学宗教—心理学]