临床路径和支付方式改革在胆结石腹腔镜手术患者中的应用效果评估

Assessment of the Effects of Clinical Pathway and Case-based Payment for Gallstones Inpatients with Laparoscopic Surgery

目的:评估临床路径和支付方式改革对胆结石实施腹腔镜手术患者的效果。方法:调取2010年1月—2011年7月项目医院和对照医院胆结石手术患者全部初次住院病例,采用倾向性得分匹配方法进行匹配后,运用双差法来评估医疗质量、医疗费用、住院床日和抗菌药物使用等指标方面的效果。结果:试点后的治愈率提高6.67%。住院费用、药费和自付费用平均分别降低2 068.09、1 275.42和1 510.39元,且药费和自付费用比例下降12.82和14.30个百分点。平均住院日和术前平均住院日分别缩短4.00和2.68天。抗生素使用天数缩短2.36天。差异均有统计学意义(P<0.05)。结论:临床路径和支付方式改革改善了医疗质量,降低了医疗费用,节约了医疗资源,提高了医疗效率。

Objective： To assess the effects of Clinical Pathway and Case-based Payment for gallstones inpatients with laparoscopic surgery. Methods： Cases of gallstones from January 2010 to July 2011 were selected from both pilot and control hospitals. The medical quality, costs, length of stay and antimicrobial drug use are analyzed by PSM （Propensity Score Matching） and DiD （Difference in Difference）. Results： After the pilot, inpatients＇ cure rate had increased by 6.67%. The average hospitalization costs, drug costs and private expenses had declined 2 068.09, 1 275.42 and 1 510.39 RMB respectively. The proportion of the drug cost and private expenses had declined by 12.82% and 14.30% respectively. The average length of stay and preoperative length of stay had declined 4.00 and 2.68 days respectively. Days of using antibiotics had been declined 2.36 days. The difference was significantly statistical （P 〈0.05）. Conclusion： The implementation of clinical pathway and payment method reform has improved medical quality, reduced health care costs and the economic burden of patients, avoided the waste of medical resources and improved hospital efficiency.