风险管理与临床路径应用研究

Improving Outcome of Medical Risk Management by Adapting Clinical Pathway

目的探讨医院风险管理中临床路径的作用。方法在临床科室组织开展单病种临床路径管理,根据不同病种,将符合入组标准的住院病例,分别设相应的观察组,之前相等时间段内既往病例设置为相应病种的对照组(历史对照)。针对腹股沟疝无张力疝修补术,将研究阶段未开展临床路径管理科室符合入组标准的病例设为对照组(同期对照)。比较观察组与对照组患者平均住院日、住院费用、治愈率或成功率、并发症发生率、满意度评分、投诉率等医疗指标的不同。结果所有病种观察组中平均住院日降低,满意度评分明显增高;绝大部分病种平均术前住院时间、住院费用、并发症发生率降低;面肌痉挛神经微血管减压术治愈率明显提高。结论提高风险管理水平不仅是医院生存发展的需要,也是现代医院管理的迫切需求,临床路径管理是一种包涵了质量保证、医疗成本控制的风险处置措施。

Objective To investigate the effects of clinical pathway in the medical risk management. Methods The observation groups were established in some clinical departments that adopted method of clinical pathway model in some single diseases. The control groups（ retrospective groups） were established respectively in the similar patients of the same departments, which were not adopted management of clinical pathway in equality time period prior. In addition, the control group （ simultaneous group） in inguinal hernia tension-free hernioplasty patients was established in another department of the general surgery at the same time as study period, which did not develop the management of clinical pathway. The differences between the different observation groups with the corresponding control groups were expected in the health-related indicators, such as the average days of hospital stay, hos- pital costs, recovery or one-time success ratio, complication ratio, patient satisfaction scores and complaints ratio, and so on. Results The average days of hospital stay reduced and the patient satisfaction scores increased significantly in all single diseases observed. The complication ratio decreased in most parts of observation groups. Healing rates were markedly enhanced in microvascular decompression for hemifacial spasm. Conclusion Improving the risk management level is not only the needs of hospital survival and development, but also the urgent requirements of modern hospital management. Including quality assurance and cost control. Clinical vathwav managment is one of risk treatment measures.