大数定理在临床路径分组管理中的应用

Application of the Law of Large Numbers in Grouped Management of Clinical Pathway

大数定理首次应用于临床路径分组管理模式,有效解决了传统临床路径管理纳入率低和退出率高的问题。借助大数定理理论,由以往病例数据和家庭调查数据得出的临床路径分组控制比例,对规范医护人员服务行为,提高医疗机构和医保管理部门资金使用效益和管理水平,以及保障患者权益具有重要意义。根据理论和实践探索得出按病种临床路径分组控制比例:简单治愈组控制比例大于等于70%,复杂好转组控制比例小于等于20%,病情严重未愈或死亡组控制比例小于等于10%,这一套经验数据可为我国推广应用临床路径分组管理提供借鉴。

The first time the law of large numbers was introduced in grouped management of clinical pathway,it solved efficiently the problem of low rate in introducing clinical pathway management and high rate in its quitting. The law of large numbers carries significant meaning in standardizing medical workers＇ behaviors, improving benefit and manage- ment of medical institutions and capital use efficiency in department of medical insurance management and guaranteeing patients＇ rights and interests with clinical pathway grouping control proportion from the past data and household survey da- ta. Then they obtain the clinical pathway grouping control proportion with theory and practical exploration：the control pro- portion of simple cure group ≥ 70% ;that of the improved complex group ≤ 20% ;and that of severe or death group ≤ 10%. The set of empirical data provides reference for popularizing and applying clinical pathway grouping management in China.