临床路径对儿童川崎病管理效果

Analysis of effect and satisfaction of clinical pathway managment on pediatric Kawasaki disease

目的探讨临床路径对儿童川崎病(KD)的管理效果及满意度。方法选取2009年1月至2013年12月住院治疗的KD患儿224例为研究对象,根据实施临床路径的时期分为非临床路径组94例和临床路径组130例,评价两组住院天数、抗生素使用率、住院总费用、治疗费、药品费用和检查检验费用,并进行满意度调查。结果两组的平均住院天数、抗生素使用率差异无统计学意义(P均>0.05)。临床路径组总住院费用为(9 597±2 199)元,检查检验费用为(1 904±421)元,高于非临床路径组的(8 014±3 330)元和(1 168±409)元,差异均有统计学意义(P<0.05);两组的治疗费、药品费差异无统计学意义(P>0.05)。问卷调查显示,临床路径没有增加患儿的满意度,医护人员对增加工作量满意度低,特别是医师。结论临床路径管理有一定优势,但应当根据我国国情和地区情况进一步改进和完善。

Objective To analyze the effect and satisfaction of clinical pathway for managing children with Kawasaki disease（KD）. Methods Data were collected from 224 children hospitalized with KD from January 2009 to December 2013. According to the implementation of clinical pathway management,all patients were divided into non-pathway management group（n=94） and pathway management group（n=130）. Length of stay,antibiotics usage,total cost of hospitalization,treatment cost,medication cost,examination cost,and laboratory testing cost were compared between the two groups. Satisfaction of clinical pathway management was surveyed. Results The average lengths of stay and percentages of antibiotics usage between the two groups were of no significant difference（P〈0.05）. The total cost of hospitalization and laboratory testing cost in clinical pathway group were（9597±2199） yuan and（1904±421） yuan,significant higher than those in non-pathway group [（8014±3330） yuan and（1168±409） yuan]. The therapy cost and medication cost between the two groups were of no significant difference（P〈0.05）. The questionnaire survey showed that application of clinical pathway did not increase the satisfaction of parents. However,the satisfaction of medical staffs was low because the increased workload,especially the pediatricians. Conclusions Clinical pathway management has some advantages,but should be further improved in accordance with national conditions and regional situation.