输入性疟疾临床路径的管理及其应用效果分析

Effect of clinical pathway management on imported malaria cases

目的探讨根据临床路径对输入性疟疾治疗的管理及其应用效果。方法收集首都医科大学附属北京友谊医院2011年1月至2012年12月期间疟疾住院患者的资料,分为临床路径组（43例,年龄25~56岁）和对照组（37例,年龄16~61岁）,评价两组患者住院天数、住院费用、临床疗效以及对疾病知识掌握程度、对医疗护理满意度情况。结果临床路径组疟疾患者平均住院天数为（6.1±1.5）d,对照组为（8±2.1）d,两组住院天数比较差异有统计学意义（P=0.000）;临床路径组和对照组总费用分别为（2766±721）元、（4 393±1392）元;西药费（576±291）元、（1145±597）元;检验费（1 355±504）元、（1 939±645）元;检查费（109±16）元、（445±73）元;治疗费（73±22）元、（104±43）元;临床路径组均低于对照组（P〈0.05）。出院时,临床路径组患者对疟疾知识掌握程度、对医疗护理满意度与对照组比较差异有统计学意义（P〈0.05）。两组间临床疗效及30d内同一疾病非计划再入院无差异。结论临床路径管理在规范医疗行为的同时降低了本病的医疗成本,避免了过度用药、检查及治疗,临床路径的健康教育模式更有利于输入性疟疾患者的护理与康复。

Objective To investigate effect of clinical pathway management on imported malaria cases.Methods The data were collected in inpatients with malaria undergone treatment in Beijing Friendship Hospital Affiliated to Beijing Capital University between January 2011 and December 2012.All patients were divided into pathway management group（n=43,aged 25—56） and control group（n=37,aged 16—61）.The two groups were evaluated regarding the length of hospital stay,medical costs,clinical outcomes and the extent of health knowledge as well as satisfaction with medical care.Results In the pathway management group,average length of hospital stay was（6.1 ±1.5） d,whereas that for the control group was（8±2.1） d（P=0.000）.Total costs in hospitalization for the pathway management group and control group were（2766±721） vs.（4 393＋1392）RMB yuan,the western medicine expenses（576±291） vs.（11451597）,laboratory cost（1 3551504） vs.（l9391645）,physical examination（109116） vs.（445173）,treatment（73122） vs.（104143）,respectively.The expense in pathway management group was significantly lower than that of control group（P0.05）.The patients in the pathway management group had better knowledge related to malaria and satisfaction with their medical care in hospital than their counterparts（P0.05）,yet the two groups remained similar concerning the clinical effect within 30 d and the unplanned readmission due to the same disease.Conclusion Clinical pathway management can regulate medical behaviors through reduction of medical costs,avoidance of excessive laboratory tests and therapy,and is more conducive to care and healing of patients with malaria.