高血压患者双向转诊临床路径的探讨与分析

Discussion and Analysis of Hypertensive Patients with Two-way Referral Clinical Path

目的探讨高血压患者双向转诊临床路径,分析高血压患者双向转诊临床路径的效果。方法 2010-03-01—2011-09-30被瑞康医院承办的社区卫生服务中心转诊到瑞康医院心内科门诊和病房的高血压患者以及被瑞康医院心内科和病房转诊到瑞康医院所承办的社区卫生服务中心的高血压患者60例为试验组,另选取同时期自发到瑞康医院内科门诊、急诊和病房就诊的高血压患者60例为对照组。采用病例查阅、专家咨询、现场考察、试点研究、个人访谈等方法,建立高血压患者双向转诊临床路径。对比两组患者再次就诊率、首次就诊时间、住院时间、医疗费用(总费用、检查费、诊疗费、药费)以及患者的满意度。结果试验组高血压患者再次就诊率较对照组明显降低,差异有统计学意义(P<0.01)。试验组高血压患者首次就诊时间较对照组明显缩短,差异有统计学意义(P<0.05);两组住院时间比较,差异无统计学意义(P>0.05)。试验组高血压患者住院总费用、检查费、诊疗费、药费较对照组均明显降低,差异有统计学意义(P<0.05)。试验组高血压患者对医护人员服务态度的满意度、诊疗技术的满意度、对转诊疗效的满意度、对医疗费用的满意度较对照组均明显升高,差异有统计学意义(P<0.05)。结论双向转诊临床路径对高血压患者再次就诊率、首次就诊时间、住院时间、医疗费用以及患者的满意度均有影响,有很好的社会效果和经济效益,是切实可行有效的临床路径。

Objective To discuss two- way referral clinical pathway in patients with hypertension and to evaluate the effect and benefit of two - way referral clinical pathway in patients with hypertension. Methods A total of 60 hypertension pa- tients both referred to Ruikang hospital from community health service center affiliated to Ruikang hospital or referred to the com- munity health service center from Ruikang hospital were selected as experiment group. Another 60 hypertension patients went to Ruikang hospital by their own were selected as control group. Clinical pathway of two - way referral of the two groups was estab- lished by reviewing cases, consulting experts, visiting sites, studying pilots and interviewing individuals. The recurrence rate, time of first visit, hospitalization, medical costs （total cost, inspection cost, clinical cost, medicine cost） and satisfactory level of patients were compared between the two groups. Results The recurrence rate of the experiment group was significantly lower than control group （P 〈 0. 01 ） . The time of first visit of the experiment group was significantly shortened compared with control group （ P 〈 0. 05 ） . The hospitalization of the two groups showed no statistically significant difference （ P 〉 0. 05 ） . The total cost, inspection cost, clinical cost and medicine cost of the experiment group were all significantly reduced compared with control group （ P 〈 0. 05 ） . The patients in the experiment group had significantly higher service satisfactory level, diagnosis and treat- ment satisfactory level, referral satisfactory level and medicine cost satisfactory level compared with control group （ P 〈 0. 05 ）. Conclusion Two - way referral is conducive to improving recurrence rate, time of first visit, hospitalization, medical cost and satisfactory level and can also make positive social impact and produce good economic benefit, so it is a practical and feasible clinical approach.