慢性肾脏病3～5期中西医结合临床路径多中心实施的效果研究

Multi-Center Implementation of Integrative Medicine-Based Clinical Pathway for Stage 3-5 Chronic Kidney Disease

目的探索及评估慢性肾脏病3～5期中西医结合临床路径多中心实施的效益。方法采用非同期历史对照,评估5家医院实施临床路径规范化管理后,患者住院天数、住院费用的改善情况。结果路径组的平均住院天数较回顾性病案组略有缩短,存在中心效应(P=0.000),经校正后平均住院天数间差异无统计学意义(P=0.621)。住院总费用较回顾性病案组稍有升高,不存在中心效应(P=0.126),组间比较差异无统计学意义(P=0.381)。费用明细支出,中药费、西药费、检查费和放射费较回顾性病案组降低,中成药费、治疗费和化验费较回顾性病案组明显升高,其中中药费、放射费、化验费组间比较差异有统计学意义(P<0.05)。结论在保证临床路径执行率的情况下,慢性肾脏病3～5期临床路径能缩短住院天数。虽未能降低住院总费用水平,但费用明细支出的改变在一定程度上体现了该路径的实施目的。

Objective To explore and evaluate the benefits of the multi-center implementation of integrative medicine-based clinical pathway for stage 3-5 chronic kidney disease（CKD）.Methods Using the historical data as the control group,we compared the improvements in the duration of hospital stay and hospital expenses were evaluated in five centers after the implementation of integrative medicine-based clinical pathways（pathway group）.Results The duration of hospital stay was a little shortened after the implementation of the clinical pathways,showing a center effect（P=0.000）;after adjustment,no statistical significance was found between the pathway group and control group（P=0.621）.The total hospital expenses in the pathway group were little higher,but was not statistically significant（P=0.381） and without center effect（P=0.126）.More specifically,the costs for traditional Chinese drugs,modern drugs,examinations,and radiology were lower in the pathway group than in control group,although the costs for Chinese patent medicines,laboratory tests（P〈0.05）,and therapeutical procedures were higher.Conclusion The application of integrative medicine-based clinical pathway shortens the duration of hospital stay in patients with stage 3-5 CKD.Although the overall costs for hospital stay remains unchanged,changes in certain items reflect the purpose of implementing the clinical pathways.