临床路径管理在乳腺癌住院患者中的应用效果

Application of Clinical Pathway Management on Inpatient with Breast Cancer

[目的]探讨临床路径管理在控制乳腺癌患者住院费用及住院天数等方面的效果。[方法]采用回顾性比较临床路径实施前后乳腺癌住院患者的相关情况,主要评价指标包括住院费用、住院天数、医疗质量等。[结果]两组患者的治疗效果、住院病死率、临床与病理诊断符合率、入院与出院诊断符合率之间差异无统计学意义(P>0.05),而临床路径组患者的住院并发症发生率明显低于对照组(8.4%vs 14.7%,χ2=4.768,P=0.009)。临床路径组的平均住院总费用、药费、治疗费、材料费均少于对照组;临床路径组平均住院总天数和术后住院天数均少于对照组(P<0.05)。临床路径组乳腺癌患者住院费用构成前3位依次为药费(57.2%)、检查费(17.8%)和手术费(9.1%),共占住院总费用的82.7%;对照组患者住院费用构成前3位依次为药费(58.7%)、治疗费(15.0%)和手术费(8.7%),共占住院总费用的82.4%。[结论]乳腺癌临床路径管理可以缩短平均住院日、降低住院费用和提高诊疗质量,值得进一步推广。

[Purpose] To investigate to the effect of clinical pathway management in controlling hospitalization expenses and hospitalization days in breast cancer patients. [Methods] A retrospective study was applied to compare the status between traditional group（control group） and clinical pathway group. The main evaluation indicators,include hospital costs,hospital days and medical quality were analyzed.[Results] The treatment effect,inhospital mortality,clinical and pathological diagnosis coincidence rate,admission and discharge diagnosis coincidence rate were not significantly difference between two groups（P〉0.05）. And in-hospital complications in clinical pathway group were significantly lower than that in control group（8.4% vs 14.7%,χ2=4.768,P=0.009）. The average total cost of hospitalization,drug cost,treatment cost,material cost,and average hospitalization days and the postoperative hospital day in clinical pathway group were lower than those in control group（P〈0.05）. The top 3 proportion of cost of inpatient in clinical pathway group was the drug fee（57.2%）,inspection fee（17.8%） and operation fee（9.1%） with accounting for 82.7% of overall cost for hospitalization expenses;while in control group,the top 3 proportion of cost was drug fee（58.7%）,treatment fee（15.0%） and operation fee（8.7%） with accounting for 82.4% of overall cost for hospitalization. [Conclusion] Clinical pathway management for breast cancer can shorten the average hospitalization days and the hospitalization costs,and improve the quality of diagnosis and treatment. It is worthy promoting further.