2013年与2010～2012年江西省基层医疗卫生机构基本诊疗路径实施情况比较研究

Comparatively studying on the implementation of basic clinical pathway in grass-roots medical institutions of Jiangxi Province in 2013 and that from 2010 to 2012

目的：对江西省2010~2012年和2013年11个设区市的24种相同常见疾病基本诊疗路径试点情况进行定量分析,为在本省建立和完善基层医疗机构诊疗路径管理制度提供依据。方法：按照分层、整群、多阶段抽样方法,前后分别随机抽取江西省11个设区市的224所和767所乡镇卫生院进行调查,并利用SPSS软件进行分析。结果：江西省11个设区市2010~2012年与2013年开展基本诊疗路径情况：前者进入路径病例9257例（24个病种）,路径完成率为92.82%;后者进入路径病例72290例（57个病种）,路径完成率为93.69%。在24个相同病种的路径完成率分别为92.82%和93.60%。在24个相同病种中,有20个病种两次试点后平均治疗费用比较差别没有统计学意义,有19个病种两次试点后平均治疗天数比较没有统计学意义。江西省11个设区市试点后平均治疗费用和平均治疗天数与各自试点前比较均有统计学意义,试点后少于试点前。结论：基本诊疗路径的实施可以减少治疗费用,缩短治疗时间,且试点后同一病种的平均治疗费用和平均治疗天数趋于一致,表明基本诊疗路径的开展具有稳定性和可行性,为实现按单病种付费和以诊断相关分组为基础的定额预付制提供依据。

Objective To quantitatively analyze the implementation of basic clinical pathway of 24 kinds of diseases in grass- roots medical institutions of Jiangxi Province, and provide references for improving the management system of clinical pathway. Methods 224 cases and 767 cases of township health centers were respectively chosen from 11 cities in Jiangxi Province with strati- fied cluster multi stage sampling method and surveyed. Data was analyzed with statistical software of SPSS. Results From 2010 to 2012,9257 cases of 24 diseases （92.82%） were involved into basic clinical pathway. While 72290 cases of 57 diseases （93. 69% ） were involved into basic clinical pathway in 2013. And the percentage of 24 kinds of same diseases being involved in was 92.82% and 93.60% ,respectively. For the 24 kinds of same diseases, no significant difference of average medical cost was ob- served in 20 kinds of diseases before and after pilots. And no significant difference of average days of treatment was observed in 19 kinds of diseases before and after pilots. There had significant differences of average medical cost and average days of treatment be- fore and after pilots in 11 piloted cities. Conclusion The implementation of basic clinical pathway can reduce the average treatment cost and shorten the average duration of treatment, which is stable and feasible. Furthermore, it can provide references for imple- mentation of Diagnostic Related Groups-Based Payment System.