人工髋关节置换术临床路径的变异分析

Variation analysis of clinical pathway in artificial hip replacement

目的:分析人工髋关节置换术临床路径中的变异因素,研究临床路径实施中存在的问题并提出改进措施。方法:采用回顾性研究方法,对237例人工全髋关节置换术病例资料进行统计,分析临床路径变异的影响因素。结果:通过对变异事项的统计分析得出:来源于医院系统的变异、可控变异、负性变异的发生率较高,分别为医院系统24.05%(57/237)、26.16%(62/237)、48.52%(115/237)。对产生变异影响最大的因素是:术前住院天数(标准化偏回归系数=0.955)。结论:本组病例CP中存在的主要问题:医院工作、制度需要改革,CP的实施需要其他工作人员的配合;没有严格的纳入、排除标准,导致与疾病转归相关的变异发生;变异信息记录不完善。

Objectlve ：To analyze the variation factors of clinical pathway in artificial hip replacement and the existing problems in implementation of clinical pathway （CP）,and to propose the measures for improvement. Methods：The data of 237 cases of artificial hip replacement were statistically analyzed for analyzing the influencing factors of clinical pathway variation.Results：The variation from hospital system,controlled variation and negative variation had higher incidence rate, which were 24.05% （57/237）,26.16% （62/237） and 48.52%（115/237） respectively. The most influencing factor to variation was hospitalization days before operation （standardized partial regression coefficient 0.995）. Conclusion：The main existing problems in CP for the patients of this group are the hospital working system needed to be reformed, CP implementation needing the coordination of other staff. No strict inclusion and exclusion criteria results in the occurrence of disease outcome related variation. The variation record was incomplete.