实施临床路径对子宫肌瘤诊治费用的影响分析

Impact Analysis of Implementation of Clinical Pathway to the Cost of Diagnosis and Treatment of Uterine Fibroids

目的比较近五年实施临床路径前后北京医院子宫肌瘤住院医疗情况及其费用变化,分析对医疗处置与费用构成比例的影响。方法回顾性分析2008年-2012年五年间我院子宫肌瘤符合临床路径入选的1356份病案,比较其住院诊治情况与费用信息,按实施临床路径前后进行资料对比分析,观察年度住院情况的变化,用SPSS16.0软件比较其统计学差异。结果近五年子宫肌瘤行子宫切除术患者的逐年平均住院日、人均护理费都有显著下降(P<0.01),人均总住院费、人均药费、检查治疗费都保持基本平稳(P>0.05);实施临床路径后子宫肌瘤总住院费用略有降低,平均住院日明显缩短,其差异都具有显著性(P>0.05),药费与检查治疗费用基本平稳(P>0.05)。进入路径626例,变异出路径93例,变异率为14.9%。结论临床路径可有效遏制了药费与检查治疗费用的不合理增长,降低平均住院日,有利于合理利用医疗资源,是确实有效的医疗改革措施。

Objective To compare changes of the average medical costs for uterine fibroids in Beijing Hospital for last five years, and investigate the effects for preliminary evaluation of clinical pathways. Methods We retrospectively analyzed the medical costs for 1356 eases of uterine fibroids treated with hysterectomy in our hospital during 2008-2012. The annual constituent ratio of medical expenses was analyzed and the cost alters after implementation of clinical pathways was compared by using SPSS16.0. Results The annual hospital stay, nursing costs was statistically lower in the last five years（P〈0.01 ）. The annual total hospital costs, drug and treatment costs were stable（P〉0. 05）. With the implementation of clinical pathways, the increase of total hospital costs of uterine fthroids has been effectively controlled, the average hospital stay was statistically significantly shorter（P〈0.05 ）, the growth of drug or treatment costs was under control（P〉0.05 ）. Muta- tion rate is 14.9%. Conclusion The unreasonable growth of drug or treatment costs was inhibited by the implementation of clinical path- ways. It can help to short the average hospital stay and rationally use medical resources. The clinical pathways were proved to be an effective health care reform measures.