对糖尿病患者查房时间与医疗质量关系的探讨

Relations between the time of clinical rounds and the quality of medical treatment in patients with diabetes

目的通过主管医生查房时间长短来说明查房时间与医疗质量关系。方法将126例住院糖尿病患者随机分为时间强化治疗组和强化治疗组。时间强化治疗组查房时间不少于20min,分早间、午间、下午查房和根据病情变化的多次随即查房;强化治疗组查房时间不少于10min,分早间、下午查房和根据病情变化的随即查房。在出院时进行日查房时间、日查房次数、住院累计查房时间、住院天数、血糖控制达标天数、相关疾病处理次数、相关疾病发现次数、诊断准确率、患者对病情诊断治疗的知晓率统计,出院后3-6个月进行强化治疗控制的情况随访。结果与强化治疗组比较,时间强化治疗组的日查房次数、日查房时间、住院天数、血糖控制达标天数、强化治疗坚持率、相关疾病处理次数、相关疾病发现次数、诊断准确率、患者对病情诊断治疗的知晓率有显著差异,而住院累计查房时间无显著差异。结论延长查房时间长和多次查房是提高医疗质量的一种手段。

Objective To explore the relations between the time of clinical rounds and the quality of medical treatment in patients with diabetes by investigating the time of clinical rounds of doctors in charge. Methods Total 126 hospitalized patients with diabetes were randomized into the time-intensive group（TI group） and intensive group. The time of clinical rounds in TI group was more than 20 minute in the morning, at the noon, and in the afternoon, respectively, and immediate clinical rounds were given by state changes of an illness. While the time of clinical rounds in intensive group was more than 10 minute in the morning and afternoon, and immediate clinical rounds were given by state changes of an illness. The time and frequency of clinical rounds per day, the accumulative times of clinical rounds during hospitalization, hospitalization days, the days of reaching a good ideal control in blood glucose, the treatment and detection frequency of related disease, the accuracy of diagnosis, patients＇ awareness rates of diagnosis and treatment were recorded at discharge. After discharge, intensive treatment was still continued for 3 - 6 months. Results Compared with in- tensive group, the time and frequency of clinical rounds per day, hospitalization days, the days of reaching a good ideal control in blood glucose, the treatment and detection frequency of related disease, the accuracy of diagnosis, patients＇ awareness rates of diagnosis and treatment in TI group had significant difference, but no significant difference in the accumulative times of clinical rounds during hospitalization. Conclusion The prolonged and more frequent clinical rounds are the measures to improve the quality of medical treatment.