临床路径模式在北京某社区支气管哮喘患者管理中的应用效果分析

Application of clinical pathway in management of patients with bronchial asthma in a Beijing community

目的 探讨临床路径在社区支气管哮喘患者管理中的应用价值.方法 采用简单随机抽样方法于2015年1月1日至2016年12月31日抽取北京市东城区新中街社区卫生服务中心管理辖区内的支气管哮喘患者110例,抽签法随机分为非临床路径组（对照组,53例）和临床路径组（试验组,57例）.对照组实施常规慢性病治疗管理,试验组实施社区临床路径模式管理.比较两组患者的哮喘控制测试（athma control test,ACT）、气流受限程度[第一秒用力呼气量占预计值百分比,（FEV1％）]、年急性发作次数、年医疗费用.结果 管理前,两组患者ACT评分[（16.72±3.90）分比（16.82±4.81）分,t=-0.13]及FEV1％[（66.8±17.43）比（68.57±19.79）,t=-0.44]比较,差异无统计学意义（均P ＞0.05）;管理前后,对照组ACT评分[（16.72 ±3.90）分比（17.23±3.47）分,t=-1.19]及FEV1％[（66.8±17.43）比（70.35 ±9.78）,t=-1.84比较差异无统计学意义（均P＞0.05）,试验组ACT评分[（16.82 ±4.81）分比（19.40 ±3.64）分,t=-6.10]及FEV1％[（68.57±19.79）比（77.03±14.04）,t=-4.83]均较1年前明显改善（均P＜0.05）;管理后试验组ACT评分[（19.40±3.64）分比（17.23±3.47）分,t=-3.20]及FEV1％[（77.03±14.04）比（70.35±9.78）,t=-2.88]均高于对照组（P＜0.05）,年急性发作次数[（1.23±0.42）次比（1.85±1.39）次,t=3.21]及年医疗费用[16 966（3 130,61 869）元比23 400（7 864,237 028）元,Z=-3.47]均少于对照组（P＜0.05）.结论 社区临床路径管理可改善支气管哮喘患者的哮喘控制水平及气流受限程度,降低急性发作风险及医疗费用.

Objective To evaluate the application of clinical pathway in management of patients with bronchial asthma in the community.Methods One hundred and ten patients with bronchial asthma were enrolled from Xinzhong community in Beijing Dongcheng district during January 2015 to December 2016.Patients were randomly assigned in two groups：53 patients were managed with conventional method （control group） and 57 patients received clinical pathway management （study group）.The asthma control test （ACT）,degree of airflow limitation （FEV1 %）,annual acute attack times and annual medical expenses were compared between the two groups.Results There was no significant difference in the ACT（16.72 ± 3.90vs.16.82±4.81 points,t =-0.13） and FEV1%（66.8± 17.43 vs.68.57±19.79,t =-0.44） between two groups before management （P 〉 0.05）.After treatments,the ACT（16.72 ± 3.90 vs.17.23 ± 3.47 points,t =-1.19） and FEV1% （66.8 ± 17.43 vs.70.35 ± 9.78,t =-1.84） in control group were unchanged （P 〉 0.05）,while the ACT （16.82 ± 4.81 vs.19.40 ± 3.64 points,t =-6.10） and FEV 1 % （68.57 ± 19.79 vs.77.03 ± 14.04,t =-4.83） in study group were improved significantly （P 〈 0.05）.After one year of clinical pathway management,the ACT （19.40 ± 3.64 vs.17.23 ± 3.47 points,t =-3.20）and FEV1% （77.03 ± 14.04 vs.70.35 ±9.78,t =-2.88）in study group were significantly higher than those in control group （P 〈 0.05）.The annual acute attack times （1.23 ± 0.42 vs.1.85 ± 1.39 times,t =3.21） and annual medical cxpenses [16 966（3 130,61 869）vs.23 400（7 864,237 028） Yuan,Z =-3.47] of study group were significantly lower than those of control group （P 〈 0.05）.Conclusions Clinical pathway management can improve ACT and FEV1 % in patients with bronchial asthma,and reduce the risk of acute attack and medical expenses.