高压氧科3个病种实施临床路径后费用分析

Analysis on the Expenses of Three Types of Diseases in High Pressure Oxygen Department after the Application of Clinical Pathways

目的研究临床路径对某院高压氧科3病种住院次均费用及药占比的影响。方法回顾性分析实施临床路径前(2009.01.01-2011.12.31)与实施临床路径后(2012.01.01-2014.12.31)急性一氧化碳中毒411例、一氧化碳中毒迟发脑病766例、突发性聋335例的住院次均费用、药占比及平均住院日的不同。结果临床路径的实施有效降低了3病药占比(P<0.01),急性一氧化碳中毒药占比由61%降至49%、一氧化碳中毒迟发脑病药占比由63%降至56%、突发性聋药占比由56%降至49%;降低了3病平均住院日(P<0.01),急性一氧化碳中毒平均住院日由15.36天降至12.73天、一氧化碳中毒迟发脑病平均住院日15.97天降至13.93天、突发性聋平均住院日13.89天降至12.08天;并降低了一氧化碳中毒迟发脑病(9600元降至8800元)、突发性聋(9400元降至8700元)的次均费用(P<0.01,P<0.05)。结论临床路径管理可合理控制医疗费用,增加非药物性治疗比例,提高病床周转率,促进医院资源的有效利用,有助于深化医疗制度改革。

Objective To investigate the application proportion of drug of acute carbon monoxide poisoning effect of clinical pathway on hospitalization expenses and （ACOP）, delayed encephalopathy after ACOP and sudden deafness. Methods Through the retrospective survey and contrastive analysis the difference of hospitalization expenses, proportion of drug and average hospitalization days between before （ 2009.01.01-2011.12. 31 ） and after （ 2012.01.01-2014. 12.31 ） the implementation of clinical pathway on the upper three types of disease. Results Implementation of clinical pathways effectively reduced proportion of drug （ P〈0. 01 ） on ACOP （61% decreased to 49%）, delayed encephalopathy after ACOP（63% decreased to 56%） and sudden deafness （56% decreased to 49%）, reduced average hospitalization days （ P〈0.01 ） on ACOP （15.36 days decreased to 12.73 days）, delayed encephalopathy after ACOP （15.97 days decreased to 13.93 days） and sudden deafness （13.89 days decreased to 12.08 days）,also reduced the hospitalization expenses on delayed en＇cephalopathy after ACOP（9600 yuan decreased to 8800 yuan） and sudden deafness（9400 yuan decreased to 8700 yuan） （P〈0. 01, P〈0.05） Conclusions Clinical pathways management can reasonably control medical expenses, increase the proportion of non drug treatment, improve the turnover rate of hospital beds, improve the effective utilization of hospital resources, and deepen the reform of medical system.