按病种分值付费方式下加速康复外科护理在消化道早癌行内镜黏膜下剥离术患者中的应用效果  

Application effect of accelerated rehabilitation surgical care in patients with early cancer of digestive tract undergoing endoscopic submucosal dissection under the diagnosis-intervention packet

作　　者：张海燕[1] 朱凌楠[1] 姜稳妮[2] 吴越 段永超 陈颂佳 Zhang Haiyan;Zhu Lingnan;Jiang Wenni;Wu Yue;Duan Yongchao;Chen Songjia(Department of Gastroenterology,the Second People′s Hospital of Jiaozuo,Jiaozuo 454001,China;Department of Disease Control,the Second People′s Hospital of Jiaozuo,Jiaozuo 454001,China;Department of Medical Records Management,the Second People′s Hospital of Jiaozuo,Jiaozuo 454001,China)

机构地区：[1]焦作市第二人民医院消化内科,焦作454001 [2]焦作市第二人民医院疾病控制科,焦作454001 [3]焦作市第二人民医院病案管理科,焦作454001

出　　处：《中国实用护理杂志》2024年第5期338-343,共6页Chinese Journal of Practical Nursing

基　　金：河南省医院管理创新研究课题(HNYGCX-2023-05B)。

摘　　要：目的探讨按病种分值付费(DIP)方式下,加速康复外科护理在消化道早癌行内镜黏膜下剥离术(ESD)患者中的应用效果。方法采用随机对照试验方法,便利抽样法选取2022年1—12月焦作市第二人民医院消化科64例消化道早癌行ESD治疗的患者为研究对象,按照随机数字表法分为常规组和观察组各32例,2组患者均以DIP方式支付医疗费用,常规组采用传统围手术期护理,观察组采用加速康复外科围手术期管理模式进行护理,比较2组患者术后并发症发生率、住院时间、DIP拨付比和患者护理满意率等的差异。结果常规组男、女各16例,观察组男14例,女18例。干预后,常规组患者术后并发症发生率为21.88%(7/32),观察组为3.12%(1/32),2组比较差异有统计学意义(χ^(2)=5.14,P<0.05);常规组患者住院时间为(10.93±2.87)d,观察组为(9.01±1.53)d,2组比较差异有统计学意义(t=4.13,P<0.05);常规组患者例均住院费用为(20108.23±6495.49)元,观察组为(18589.03±4439.46)元,2组比较差异有统计学意义(t=20.57,P<0.05);观察组DIP拨付比为87.98%(303419.26/344872.99),常规组为69.33%(244864.99/353187.65),2组比较差异有统计学意义(χ^(2)=4.81,P<0.05);观察组护理满意率为96.88%(31/32),常规组为78.13%(25/32),2组比较差异有统计学意义(χ^(2)=5.14,P<0.05)。结论DIP方式下,加速康复外科护理能有效降低消化道早癌行ESD治疗患者的术后并发症、住院时间、例均住院费用,提升ESD病种医疗保险基金拨付比和患者护理满意度,体现了护理工作的价值,可推广应用到其他手术病种的护理管理中。Objective To evaluate the effect of accelerated rehabilitation surgery(ERAS)under diagnosis-intervention packet(DIP)in patients with early cancer of digestive tract undergoing endoscopic submucosal dissection(ESD).Methods The 64 patients with early cancer of digestive tract treated with ESD in the Gastroenterology Department of the Second People′s Hospital of Jiaozuo were selected by randomized controlled trial and convenient sampling method.According to random number table method,they were divided into routine group and observation group,32 patients in each group.All patients in the 2 groups paid their medical expenses by DIP method,the routine group was treated with traditional perioperative nursing,and the observation group was treated with ERAS perioperative management mode.The postoperative complication rate,length of hospital stay,DIP allocation ratio,and patient satisfaction with nursing were compared between the two groups.Results There were 16 men and women in the routine group,14 men and 18 women in the observation group.After intervention,the incidence of postoperative complications was 21.88%(7/32)in the routine group and 3.12%(1/32)in the observation group,and the difference between the two groups was statistically significant(χ^(2)=5.14,P<0.05).The length of stay was(10.93±2.87)d in the routine group and(9.01±1.53)d in the observation group,and the difference between the two groups was statistically significant(t=4.13,P<0.05).The average hospitalization expenses per case was(20108.23±6495.49)yuan in the routine group and(18589.03±4439.46)yuan in the observation group,and the difference between the two groups was statistically significant(t=20.57,P<0.05).The DIP allocation ratio of the observation group was 87.98%(303419.26/344872.99),and that of the routine group was 69.33%(244864.99/353187.65),and the difference between the two groups was statistically significant(χ^(2)=4.81,P<0.05).The satisfaction of the observation group was 96.88%(31/32)and the routine group was 78.13%(25/32),and the di

关 键 词：按病种分值付费 加速康复外科 消化道早癌 内镜黏膜下剥离术 

分 类 号：R473.73[医药卫生—护理学]