临床路径和主诊医师负责制联合服务模式的实践

Ehploration of the service pattern combined the clinical path with the master physician responsibility system

目的探索临床路径和主诊医师负责制联合服务模式的临床应用价值。方法选择子宫肌瘤、卵巢囊肿、剖宫产手术和正常分娩、妊娠引产作为临床路径研究对象(实验组),制定各病种《临床路径诊疗护理流程》并组织实施;制定《主诊医师负责制实施与考核办法》并成立主诊医师小组,把病区医疗工作和医疗资源平均分配给主诊实验组和主诊对照组。取联合服务模式实施后和前1年同期全部住院病人,分别统计各组诊疗信息。结果实施联合服务模式后:(1)出院人次、手术人次、病床使用率、周转率明显高于对照组;(2)住院天数明显缩短,人均住院费用明显下降,临床路径组更明显。(3)主诊医师组手术病例明显增多,特别是癌肿和腔镜病例,提高了病人的信任度和满意度;全部病例人均住院天数缩短。结论联合服务模式有机结合明显减少病人住院时间和住院费用,并可提高医疗工作效率、增加医疗资源利用率,实现功能渗透、优势叠加、效益互补。

objective To explore the clinical value of the service pattern combined the clinical path with the master physician responsibility system. Methods Hysteromyoma, ovarian cyst, uterine-incision delivery, normal delivery and induction de- livery were selected to the research objects. The group of master physicians was formed. And we formulated the practical means concerning the clinical path and the master physician responsibility system. The hospital patients during one year before and after enforcing the new pattern were limited. The medical task and resource were distributed equally to the experimental and control group, and the two groups were compared. Results By the new pattern, the experimental group was obviously higher than the control group in the man-time of discharge and operation, the usage and turnover rate of bed. The hospital day was shorter and the average cost of hospitalization was fewer than before. The operation case of the master physician group increased, especially in tumor and laparoscope, which raised patient＇s confidence and satisfaction. Conclusion The combined service pattern could decrease the day and cost of hospitalization, raise medical work efficiency and increase medical resource availability.