带状疱疹的临床路径实施效果评价研究

Evaluation of implementation effect of clinical pathway for shingles

目的分析评价带状疱疹临床路径实施的效果,并提出相应的政策建议。方法选取1 044例带状疱疹患者,按有无实施路径化管理分为对照组(n=343)和临床路径组(n=701)。比较两组间平均住院天数、人均住院总费用、各单元费用及其比例的差异。选取相关行政管理人员和医护人员进行个案访谈。结果药品费用占总费用比例、护理费用、住院天数和诊疗费用为住院总费用的主要影响因素(r=0.867、0.760、0.747和0.747,均P=0.000)。临床路径组的住院天数比对照组少1.03 d,住院总费用下降312.68元,差异均有统计学意义(P=0.003和P=0.045),其中药品费、诊疗费、床位费和检查费均显著降低(P<0.05或P<0.01)。行政管理和医护人员普遍认为临床路径有利于改善医患关系,但是增加了一定的工作量。结论全面支持临床路径的深化与推进,完善相应的政策措施;细化和优化临床路径表单,合理分配医疗资源;配套相应激励措施,提高临床及行政人员的积极性。

Objective To evaluate the implementation effect of clinical pathway for shingles and to propose corresponding policies. Methods A total of 1 044 patients with shingles were selected and divided into two groups according to whether the clinical pathway was implemented, i.e. the control group （ n =343） and the clinical pathway group （ n =701）. The differences of average hospitalization days, total hospitalization expenses per capita, and cost and ratio per unit of two groups were compared. Case interviews with relevant administrators and medical staff were also carried out. Results The major influence factors of the total hospitalization expenses were the proportion of drug expenses, nursing expenses, hospitalization days, and consultation fees （ r =0. 867, 0. 760, 0. 747, and 0. 747, P =0. 000）. Compared to the control group, the hospitalization days of the clinical pathway group were 1.03 days fewer and the total hospitalization expense per capita was 312.68 yuan cheaper. The differences were statistically significant （P=0. 003 and P=0. 045）. The drugs expenses, consultation fees, bed fee, and examination fees were all significantly reduced （P〈0.05 or P〈 0.01）. Administrators and medical staff generally believed that the clinical pathway benefited the doctor-patient relationship, but increased the workload. Conclusion Wider implementation and continuous improvement of clinical pathway should be fully supported and corresponding policies should be perfected. The clinical pathway forms require further elaboration and optimization and the medical resources need to be allocated reasonably. Relevant incentive measures should be made so as to improve the enthusiasm of clinical and administrative staff.