实施临床路径及按病例支付前后医疗行为和服务质量变化分析:以腹股沟疝为例

Analyzing the changes of medical treatment and quality of medical service before and after the introduction of Clinical Pathway and Case-based Payment sampled with inpatients with inguinal hernia

目的:评估县级医院临床路径及支付方式改革试点后医疗行为和质量效果。方法:调取2010.1～2011.7项目与对照医院在试点前后的腹股沟疝全部病例,应用倾向得分匹配法和倍差法来评价试点病种的医疗质量、住院日和抗生素使用方面的效果。结果:试点后腹股沟疝的平均住院日和术前平均住院日分别缩短0.44天和0.69天;抗生素使用天数下降0.25天,使用种类下降1.14种;治愈率提高了6.25个百分点;预防用药率降低62.50个百分点。结论:临床路径及支付方式改革试点促使医院提高了效率,改变了医疗处方行为,改善了医疗服务质量。

Objective To evaluate the changes of medical treatment and quality of medical service before and after the reform on Clinical Pathway and Case-based Payment in county hospitals. Methods All cases of patients with inguinal hernia before and after the reform were collected from both pilot and control hospitals from Jan. 2010 to Jul. 2011, and analyzed from aspects of quality of medical service,length of stay and antibiotic using with PSM and DID. Results After the pilot,the average length of stay and preoperative length of stay had been declined for 0.44 and 0.69 days respectively. Days and types of using antibiotics had been declined for 0.25 days and 1.14 types respectively. The cure rate had increased by 6.25 percent. And the rate of antibiotic prophylaxis using had reduced by 62.50 percent. Conclusion The reform on clinical pathway and payment method had improved the hospitals＇ efficiency, medical care quality and prescription behaviors.