脑梗死临床路径实施效果评价

Evaluation to the effects of a clinical pathway for acute intracerebral ischemic infarction

目的评价脑梗死临床路径的实施效果。方法采用非同期队列研究比较实施临床路径前(传统组)与实施临床路径后(路径组)患者的主要相关情况。主要评价指标包括:①住院时间;②住院费用;③治疗效果(神经功能缺损程度、日常生活能力、住院并发症、住院病死率、治疗90天再住院率、治疗90天病死率)。结果与传统组相比,路径组患者的住院天数缩短(21.82±11.72天vs17.85±7.54天,P=0.006),住院费用降低不明显(11924.76元vs10030.50元,P=0.230),其中检验费和其他费用下降明显,药物费有下降趋势,治疗费略有上升,而平均日费用有上升趋势。治疗90天后患者生活能力(BI)有提高(P<0.05),住院并发症发生率下降明显(P<0.05),但治疗14天后患者神经功能缺损程度及治疗90天后再住院率、病死率差异无统计学意义(P>0.05)。结论实施脑梗死临床路径能够改善医疗质量,更好地利用医疗资源,值得进一步推广应用。

Objective The purpose of present study is to evaluate the effects of a clinical pathway for cerebral apoplexy,and to provide evidences for further improving the pathway.Methods Prospective cohort study was applied to compare the status between the traditional group（patients admitted during December 2003 to April 2004）and the clinical pathway group（patients admitted during May 2004 to November 2004）,for whom the clinical pathway was applied.The main criteria for evaluation were：① mean length of stay in hospital,② costs of hospitalization,③ therapeutic efficacy including the degree of neurological impairment,activities of daily living（Barthel Index）,hospital complications,readmission rates after 90-day therapy,and fatality rate after 90-day treatment.Results A total of 195 patients were studied,among them 90 were investigated during the period before the implement of clinical pathway,and 105 were investigated during the implementation of clinical pathway.Compared to the traditional group,it was found that the length of stay in hospital shortened of the patients in clinical pathway group（21.82±11.72 vs 17.85±7.54,P=0.006）,the hospitalization costs slightly decreased from RMB 11 924.76 to 10 030.50,the costs for drugs and examination were also decreased,while the costs for medical treatment raised slightly.It was also found that the Barthel Index,which demonstrated the ability of daily living of patients,increased significantly after 90-day treatment with clinical pathway.No significant difference was observed in the improvement of neurological impairment,and the activities of daily living after 14-day treatment.No significant difference existed in the incidence of in-hospital complications,90-day fatality rate,and 90-day readmission rate between the traditional group and the clinical pathway group（P〉0.05）.Conclusion The application of clinical pathway on patients with ischemic stroke can improve the quality of medical care with reasonable cost,and it deserves to be used more widely.