系统变异管理对临床路径的影响

Effect of Clinic Path Caused by System Variation Management

目的 研究临床路径实施过程中出现的系统变异及变异原因,探索干预措施,旨在降低可控变异的发生率.方法 选择妇科、神经内科两个试点科室共11个病种为受试对象,将2011年1月～6月进入临床路径的受试对象1682例设为对照组,将2012年7月～12月进入临床路径的受试对象5 639例设为研究组,比较两组的变异差异情况.结果 对照组病例数1 683例,变异例数489,变异率29.1％;研究组病例数5 639,变异数962,变异率17.06％.两组比较,因主管医生检查滞后、检查结果滞后、费用滞后、不配合检查、自动出院,路径设计缺陷原因引起的变异有显著差异,P＜0.05;因设备故障,共病情况原因引起的变异无显著差异,P＞0.05.主管医生检查滞后、检查结果滞后和路径设计缺陷能够单独引起系统变异,P＜0.05.而设备故障不能单独引起系统变异,P＞0.05.结论 通过全面优化医疗服务流程,完善信息化建设、加强医院硬软件建设等措施,能够明显降低由于系统管理缺陷导致的临床路径系统变异,明显减少临床路径负变异,增加正变异.

Objective To discuss the system variation and the reasons during the performance of clinic path, then explore the relative intervention measures, to decrease the rate of controllable variation. Method Choosing 11 entities to be the testing subject among department of gynecology and department of neurology, 1 682 cases which got into clinic path from January to June, 2011 are divided into compare group, and statistical analysis the system variation, the reasons and relative intervention measures which include completely grading - up the clinic service process, improve informationalized construction, strength the management of component element, improve the construction of software and hardware facilities, then have full scale operation among each de- partment in hospital and have effective intervention. Result There are 1 683 cases in compare group, in which 489 cases are variation, and the rate of variation is 29.1%. while there are 5 639 cases are in research group , in which 962 cases are variation, and the rate of variation is 17.06%. Comparing the two groups, the differences of variation are obvious caused by misdiagnosis, the delay of diagnosis, the delay of check conclusion , delay of funds, reluctant to check, discharge on their own, p 〈 0.05, while there is no obvious difference caused by the breakdown of equipments or common situation, p 〉 0. 05. Conclusion To improve the management, the clinic service process, informational construction, hardware and software construction, can obviously decrease the clinic path variation caused by defect management, and can obviously decrease negative variation and increase positive variation in clinic path.