急性心肌梗死病种质量影响因素分析

Analysis on the Influencing Factors of the Disease Category Quality in Acute Myocardial Infarction Patients

目的了解急性心肌梗死病种质量影响因素,以规范诊疗流程,提高病种质量和管理水平。方法回顾性调查2011年急性心肌梗死患者的急诊和住院病历,按照质量标准进行统计与分析。结果 193例患者中,治愈好转患者170例,平均住院日14.5天,未实施PCI手术患者平均费用8624.18元,PCI手术患者平均费用44144.4元。在环节质量指标调查中,入院24小时内能完成心脏超声检查115例,未在标准时间内完成78例;35例实施药物溶栓的患者,药物溶栓开始时间均超过标准时间;110例实施PCI手术患者,在标准时间内完成41例,超过规定时间完成69例;实施低密度脂蛋白胆固醇评估仅28例,实施健康教育尤其是戒烟劝告与咨询仅35例。还存在病历书写不规范和用药不合理因素。结论医院应制定病种诊疗流程、进行医院培训和科室内训、设计开发单病种临床路径系统、加强病历质量监控等,持续改进急性心肌梗死病种质量。

Objective By studying the factors influencing the disease category quality of acute myocardial infarction （AMI）, we aim to standardize the procedures of disease diagnosis and treatment and to improve the quality control of different disease categories. Methods A statistical analysis based on quality control standards was carried out through a retrospective investigation of the emergency and inpatients medical records of AMI patients in 2011. Results In 193 patients, 170 patients were cured or improved, with an average hospital stay of 14.5 days. The average cost of the patients un- dergoing PCI surgery is 44144.4 yuan and 8624.18 yuan for those who didn＇t undergo PCI surgery. In the investigation of quality indicators in differ- ent steps, 115 cases complete echocardiography within 24 hours of admission while 78 cases did not within the standard time. In 35 patients with the implementation of drug thrombolysis, the starting time of thrombolysis all exceeded the standard time. In 110 patients undergoing PCI surgery, 41 cas- es were completed within the standard time and 69 cases exceeded the standard time. Only 28 cases underwent the assessment of low-density lipoprotein cholesterol. Only 35 cases received health education which includes smoking cessation advice and counseling. Non-standard medical records and unrea- sonable application of medication exist as well. Conclusions The standard diagnosis and treatment procedures for different disease categories, hospital training, internal training in all departments, the development of single disease clinical pathway system and the reinforced monitoring of medical records quality are essential for the continual improvement of disease categories quality in AMI patients.