2018—2021年安徽省公立综合医院临床路径管理现状及影响因素分析  

Analysis of Implementation and Management Situation and Influencing Factors of Clinical Pathways in Public General Hospitals in Anhui Province from 2018 to 2021

作　　者：张潘 周勤 沙良瑞 冯佳佳 张瑜[1] 韩勇 靳英辉 林丽开 Zhang Pan;Zhou Qin;Sha Liangru(Wuhan University Hospital Management Institute,Wuhan,Hubei,430071,China;不详)

机构地区：[1]武汉大学医院管理研究所,湖北武汉430071 [2]安徽省临床路径管理中心,安徽芜湖241000 [3]武汉大学中南医院循证与转化医学中心,湖北武汉430071

出　　处：《中国医院管理》2024年第12期50-54,共5页Chinese Hospital Management

基　　金：国家卫生健康委医疗管理服务指导中心委托项目(2022YG053)。

摘　　要：目的 分析2018—2021年安徽省16个地市53家公立综合医院临床路径实施现状及影响因素,为加强临床路径管理提供依据。方法 2022年12月—2023年3月,采用问卷星对临床路径管理实施现状进行问卷调查。结果 2021年53家公立综合医院实施临床路径的科室平均数为23.56个,病种平均数为228.75个,平均入径率为88.58%,平均覆盖率为69.08%,平均完成率为92.85%,达到国家要求,但4年间科室数、覆盖率和完成率上升幅度较小。医院级别、信息系统上线时间、临床路径牵头人职务、是否与科室及个人奖金挂钩、是否将临床路径与DRG/DIP相结合对临床路径实施效果影响差异均有统计学意义(P<0.05)。结论 自2015年组建临床路径管理中心以来,安徽省每年对全省二级及以上公立医院的临床路径管理督查工作推动了临床路径工作的落地,但2018年后进入管理。建议加强医院领导重视、信息化管理、开展临床路径与医保支付方式的融合,实现成本控制与合理诊疗的平衡。Objective To analysis the current situation of clinical pathway implementation and management of 53 public general hospitals in 16 cities in Anhui Province from 2018 to 2021,so as to provide a basis for further strengthening the management of clinical pathways in Anhui Province.Methods From December 2022 to March 2023,questionnaire stars were used to conduct a questionnaire survey on the implementation status of clinical pathway management.Results In 2021,53 public general hospitals implemented an average of 23.56 clinical pathways,228.75 diseases,88.58%of the average admission rate,69.08%of the average coverage rate,and 92.85%of the average completion rate,meeting the national requirements.However,the number of departments,coverage and completion rate showed a small increase over the past four years.The hospital level,the time of information system implementation,the position of the clinical pathway leader,whether it is linked to departmental and individual bonuses,and the integration of clinical pathways with DRG/DiP payment methods all have statistically significant effects on the implementation effectiveness of clinical pathways(P<0.05).Conclusion Since the establishment of the Clinical Pathway Management Center in 2015,Anhui Province has promoted the implementation of clinical pathway management in the province's second-level and above public hospitals every year,but it has entered management after 2018.It is suggested that Anhui Province should strengthen the attention of hospital leaders,information management and the integration of clinical paths and medical insurance payment methods in the future,so as to achieve a balance between cost control and reasonable diagnosis and treatment.

关 键 词：公立综合医院 临床路径 医保支付方式 安徽 

分 类 号：R197.323.2[医药卫生—卫生事业管理]