我国临床路径的管理现状及发展策略

Situation and Development Strategy of Clinical Pathway Management in China

目的:评价我国临床路径(CP)管理中存在的不足,并提出改进建议。方法:通过查阅国内外的相关文献,结合我院CP的实施情况,阐述我国CP管理的现状、存在的问题及对完善CP管理提出建议。结果:由于地区、医院规模等差异,导致我国CP管理存在较多问题,如医院管理层重视程度不足、一线医护人员对CP认识欠缺以及控制医疗费用不够理想、缺乏有效的监管和评价方法等。我院通过实施CP管理使得13个嵌入临床合理用药决策支持系统的路径患者入径率达51%、完成率达76.3%;入径患者的平均住院时间由未入径之前的7.35 d下降至5.72 d,平均住院药品费用由3 050.84元降低至2 488.53元,药占比由37.0%下降至24.0%。结论:通过实施CP管理,我院各项医疗指标明显改善,但综合我院管理方法及目前国内CP管理现状来看,我国CP管理还存在一定的问题,需要进一步深入探讨,包括建立有效的评价和监管方式、加强临床药师在药物治疗团队中的作用;同时,建议借鉴企业引入高效、持续质量改进方法,并结合信息化网络技术,提高CP管理的效果。

OBJECTIVE： To evaluate the insufficiency of clinical pathway （CP） management in China and give some suggestion. METHODS： By reviewing domestic and foreign literatures, based on the implementation of CP in our hospital, the situation and problems of CP management in China were interpreted, and the suggestion was put forward. RESULTS： Due to regional disparity and differences of hospital size, there were many problems of CP management in China, such as managers didn＇t pay enough attention to CP; medical staff lacked of knowledge about CP; expense control was not ideal; effective monitoring and evaluation methods were absent. With the use of CP management in our hospital, the rate of admittance of patients involved in 13 pathways embeded in Clinical Rational Administration Decision-Support System was 51% with the finishing rate of 76.3%. The average stay of the patients decreased from 7.35 d before involved in pathway to 5.72 d after involved in pathway; the average drug cost de- creased from 3 050.84 yuan to 2 488.53 yuan, and the medicine proportion decreased from 37.0% to 24.0%. CONCLUSIONS： With the use of,CP management in our hospital, the medical indexes have been improved obviously. Based on the management method in our hospital and the situation of CP management in China, there are certain problems in clinical pathway management. It needs to be further deeply investigated, involving establishing effective methods of evaluation and monitoring, and strengthening the effect of clinical pharmacists in treatment team. At the same time, it is suggested to improve the effect of CP management by introducing effective and continuous quality improvment methods, combining with information network technology.