急性胰腺炎中医临床路径的卫生经济学评价

Health Economic Evaluation of Clinical Pathway of Traditional Chinese Medicine in the Treatment of Mild Acute Pancreatitis

目的评价四川大学华西医院应用轻症急性胰腺炎(mild acute pancreatitis,MAP)中医临床路径的卫生经济学价值。方法路径组前瞻性纳入2012年6月至2013年2月MAP患者91例,非路径组回顾性分析2011年6月至2012年5月80例MAP患者临床资料。比较两组在平均住院时间、住院费用(人民币,单病种均次总费用、总治疗费、中医治疗费、中草药费、西药费、护理费)、抗生素使用率、生长抑素使用率、腹痛消失时间(h)、发病到再进食时间(h)、患者满意度(百分制)的差别。结果两组患者在人口学参数、病因、Ranson和Balthazar CT评分的差异均无统计学意义(P>0.05)。路径组的抗生素使用率(54.5%)、生长抑素使用率(0%)、腹痛消失时间为(68.26±39.57)h、发病到再进食时间为(98.69±45.53)h、患者满意度(95.79±1.52)%,较非路径组的抗生素使用率(81.3%)、生长抑素使用率(15%)、腹痛消失时间〔(90.29±31.35)h〕、发病到再进食时间〔(118.51±40.91)h〕、患者满意度〔(92.10±1.73)%〕等均有明显改善(P<0.05)。路径组平均住院时间为(7.36±2.81)d,较非路径组(8.36±2.81)d缩短(P<0.05)。路径组患者的单病种均次住院总费用〔(8 960.34±4 328.91)元〕、西药费〔(3 988.28±2 128.10)元〕、护理费〔(93.32±35.20)元〕较非路径组的单病种均次住院总费用〔(11 089.89±4 318.29)元〕、西药费〔(6 563.80±2 743.87)元〕、护理费〔(110.51±37.24)元〕均有减少(P<0.05);路径组的中医治疗费〔(968.29±769.68)元〕、中草药费〔(303.49±149.90)元〕较非路径组的中医治疗费〔(609.59±624.42)元〕、中草药费〔(162.72±135.13)元〕有所增加(P<0.05);两组的总治疗费差异无统计学意义〔路径组(1415.39±899.84)元,非路径组(1135.80±753.97)元,P>0.05)〕。结论实施轻症急性胰腺炎中医临床路径,在保证疗效的基础上,可缩短平均住院时间,降低医疗成本,提高患者满意度。

Objective To evaluate the health economic value clinical pathway （CP） of traditional Chinese medicine in the treatment of mild acute pancreatitis （MAP）. Methods Ninty one patients with MAP were enrolled prospectively in TCM clinical pathway group from June 2012 to February 2013, while the data of 80 MAP patients who were treated without TCM clinical pathway from June 2011 to May 2012, were analyzed retrospectively as control group. The health economic evaluation data used for the two groups comparison included： average length of stay, hospitalization expenses （total hospitalization expenses, total treatment cost, TCM treatment cost, herbal fees, medicine fees, and nursing care cost）, as well as the usage of antibiotics/somatostatin, the release time of abdominal pain, the time of re-feeding, and patient satisfaction. Results There were no significant statistical differences in demographics, etiology, Ranson and Balthazar CT scores between the two groups （P 〉 0. 05）. Compared with non-CP group, the usage of antibiotics and somatostatin, the release time of abdominal pain, the time of re-feeding and patient satisfaction were all improved significantly in CP group （P〈0.05）. The average length of stay in CP group was shorter than that of non-CP group （P〈0.05）. Total hospitalization expenses [￥（11 089.89± 318.29） vs. ￥ （8 960. 34± 328. 91）3, medicine fees [￥ （6 563. 80±2 743. 87） vs. ￥ （3 988.28_＋2 128.10）3 and nursing care cost [￥ （110.514±37.24） vs. ￥ （93.32±35.20）] were all reduced in CP group, while TCM treatment cost [￥ （609. 59±624. 42） vs. （968. 29±769. 68）3 and herbal fees [￥ （162.72±135. 13） vs. Y（303.49±149.90）3 were increased （P〉0. 05）. There was no significant statistical difference in total treatment cost between the two groups （P〉0.05）. Conclusion TCM clinical pathway of MAP can not only ensure the therapeutic effects, but also shorten the average length of stay, reduce medical cost and increase patient satisfaction.