河北某三级综合医院实施脑梗死临床路径的效果评价

Impact Assessment of Clinical Pathway Management of Cerebral Infarction of a Tertiary General Hospital in Hebei Province

目的评价实施脑梗死临床路径的临床效果。方法收集河北某三级综合医院2013年-2016年脑梗死住院患者信息655例(临床路径组)和704例(非临床路径组),观察实施临床路径管理对临床诊断、病案书写质量、临床用药、住院时间、医疗费用、辅助检查项目选择、患者满意度的影响。结果临床路径组患者出院病案甲级率为96.03%明显高于非临床路径组85.94%;乙级率为3.97%明显低于非临床路径组14.06%;临床路径组药占比为35.66%,明显低于非临床路径组的42.18%;目录内用药比例为96.81%,明显高于非临床路径组的87.20%;临床路径组平均住院天数为13.82±4.29明显低于非临床路径组17.07±5.04;临床路径组总费用、药费、化验费、检查费均明显低于非临床路径组;临床路径组患者对医护工作的满意度为92.37%,优于非临床路径组的85.51%,以上比较P<0.05,均差异有统计学意义。结论对脑梗死实施临床路径能够合理规范医疗行为,保障医疗安全,提高患者满意度。

Objective To evaluate the clinical influences on managing the clinical pathway of cerebral infarction. Methods 655 cases （clinical pathway group） and 704 cases （non-clinical pathway group） diagnosed as cerebral infarction in Tertiary General Hospital in Hebei Province from January 2013 to December 2016 were selected. Clinical diagnosis, medical record quality, clinical drug, hospitalization time, medical expense, and auxiliary examination choose, and satisfaction were recorded. Results Medical record grade-A rate in the implementation of clinical pathway group was 96.03%, which was significantly higher than no-implementation group （85.94%）, and grade-B rate was 3.97%, which was significantly lower than that no-implementation group （14. 06%） ;＇ Drug proportion in the implementation group was 35.66%, which was lower than that of no-implementation group （42. 18%）, and medicine proportion within the directory in the implementation group was 96.81%, which was significantly higher than that in no-implementation group （87.20%） ; Total cost, expenses for medicine, laboratory fees, examination fees in the implementation group were significantly lower than those in no-implementation group; The satisfaction degree in the implementation group was 92.37%, which was more superior than that in no-implementation group（85.51%）, and the above differences were statistically significant, all P〈0. 05. Conclusion Managing clinical pathway on cerebral infarction can regulate the physician-nursing behavior, improve medical security and patient satisfaction.