基于病历会商制度的动脉瘤性蛛网膜下腔出血医疗效率改进模式--一种持续高效的脑血管病医师继续教育方式

The Mode of Medical Service Efficiency Improvement of Aneurysmal Subarachnoid Hemorrhage Based on Case-Consultation System——A Sustainable Effective Way of Continous Education for Cerebrovascular Physicians

目的探讨基于病历会商制度的动脉瘤性蛛网膜下腔出血(aneurysmal subarachnoid hemorrhages,aSAH)医疗服务效率改进模式对脑血管病医师的继续教育作用及其成效分析。方法首都医科大学附属北京天坛医院自2013年7月开始对脑血管病医师进行基于病历会商制度的aSAH治疗效率持续改进模式教育,评价2013年1月-6月与2017年7月-12月两个时间段脑血管病医师对aSAH患者发病72 h内介入栓塞或外科夹闭术治疗率变化及患者到院距接受治疗平均时间的差异。结果通过基于病历会商制度的aSAH医疗服务效率改进模式的继续教育制度,脑血管病医师对aSAH患者的治疗效率有显著改善[患者发病72h治疗率:83.6%vs 55.3%,P<0.001;患者到院距接受治疗的平均时间:(45.0±31.3)h vs(78.6±51.8)h,P<0.001]。结论基于病历会商制度的aSAH医疗服务效率改进模式是一种持续高效的脑血管病医师继续教育方式。

Objective To explore the continuous education effect of aneurysmal subarachnoid hemorrhage（aSAH） medical service improvement model based on case-consultation system for cerebrovascular physicians.Methods The education model of aSAH treatment efficiency improvement based on the caseconsultation system for cerebrovascular physicians was applied in Beijing Tiantan Hospital, Capital Medical University since July 2013. The treatment rates improvement of interventional embolization/surgical clipping and the mean time from door to treatment were compared between two stages of Jan. 2013-June.2013 and July 2017-Dec. 2017 in patients with aSAH within 72 hours after onset.Results The treatment efficiency for aSAH patients was significantly improved by the continuous education based on the case-consultation system [The treatment rate within 72 hours was 83.6% vs 55.3%, P 0.001; time from door to treatment was（45.0±31.3）h vs（78.6±51.8）h, P 0.001].Conclusion The aSAH medical service improvement model based on the case-consultation system is a continuous and highly effective education way for cerebrovascular physicians.