临床路径管理在短暂性脑缺血患者中的初步应用及变异分析

Application and Variation Analysis of Clinical Pathway Management in the Patients with Transient Ischemic Attack

目的探讨临床路径(clinical pathway,CP)管理在短暂性脑缺血患者中的应用及变异情况。方法 73例符合CP管理入径标准者,按既定短暂性脑缺血管理流程进行诊疗操作(CP)组。将此前非CP管理患者作为对照组,采用SPSS11.5软件对资料进行统计分析,对比两组间平均住院日、平均住院费以及其中药品费用所占的百分比、患者出院满意度评分及缺血性卒中的发生率等量化指标的差异,并对其中变异情况进行分析。结果实施临床路径后,患者平均住院日、平均住院费用下降、患者满意度提高、药品所占住院费用百分比及缺血性脑梗死发生率明显降低,P<0.05差异有统计学意义。CP组入径率48%,变异率达42.5%,其中,83.87%的变异为与病人相关;与医院系统相关的变异16.13%;与医务人员相关的变异为0。结论 CP管理可规范短暂性脑缺血发作的诊疗措施,降低患者的药费,显著提高患者的预后,降低急性缺血性卒中发生率。加强CP管理的医患教育是推行CP管理的关键。

Objective To investigate the priority of clinical pathway in patients with transient ischemic attack and analyze the variation during this procedure. Methods 73 patients with transient ischemic attack, who fitted clinical pathway management, were as the CP group and 70 patients with the same condition are as the control group. SPSS 11.5 soft ware were used to analyze the date. Average hospitalization length, the average hospitalization cost, the percentage of drug costs, patients discharged from hospital satisfaction score, and the incidence of ischemic stroke are compared between the two groups. Variation in CP management is also analyzed. Results After applying the clinical pathway, the average hospitalization days, average hospitalization expenses decreased; patients satisfaction improved; medicine in hospitalization costs and the incidence of ischemic cerebral infarction significantly reduced, there are significant differences P〈0.05. The ratio of clinical path group, which fits clinical pathway management, is 48%. 42.5% cases variate from CP management, of which, 83.87% variation is associated with the patient; 16.13% variation associated with the hospital system; variants associated with medical personnel is 0. Conclusion CP management can standardize diagnosis and treatment of transient ischemic attack, reduce patients drug cost, significantly improve the prognosis of patients, reduce the incidence of ischemic cerebral infarction. To strengthen the medical education CP management is the key to carry out CP management.