经阴道子宫切除术实施不同临床路径的成本效益比较

Analyses of cost and effectiveness associated with different clinical pathways of transvaginal hysterectomy

目的分析不同临床路径经阴道子宫切除术患者的住院时间和费用,探索一种高效低费用的诊疗模式。方法从佛山市妇幼保健院病案首页管理系统中选择2012年至2014年在该院行经阴道子宫切除术的患者进行研究。随机原则将纳入病例分为临床路径A组(据我院情况设计的临床路径)和临床路径B组(卫生部2009公布的子宫切除术临床路径)两组,对两组患者的住院时间和住院期间的费用进行分析。结果共77例子宫切除术患者纳入分析,其中临床路径A组44例,临床路径B组33例,2组患者的住院时间均值为7.12 d、8.20 d。两者相比,有显著性差异(P<0.05),A组和B组阴式子宫切除患者住院期间的平均总费用分别为9 495.76元、12 348.37元,两者相比,差异有统计学意义(P<0.05),两组费用构成中,两组间护理费、床位费、药费、麻醉费用相比差异有统计学意义(P<0.05),B组高于A组,住院原因是手术住院时间较长。A组和B组的患者满意度无明显差异,但A组的满意率高于B组。结论据我院情况设计的临床路径组住院时间比卫生部2009公布的子宫切除术临床路径组短,住院期间的费用差异有统计学意义。

Objective To examine the length of hospital stay and expenses associated with different clinical pathways of transvaginal hysterectomy so as to provide comparative information about high-effient and low-cost pathway of transvaginal hysterectomy in China. Methods Hospital discharge data on transvaginal hysterectomies performed in our hospital from 2012 to 2014 were retrieved. The cases were classified into 2 groups randomly: group A ( whose clinical pathway was designed according to our hospital situation) and group B ( whose clinical pathway was announced by the Ministry of Health in 2009 ) . The length of hospital stay and expenses associated with transvaginal hysterectomy were analyzed retrospectively. Results Records of 77 women who underwent transvaginal hysterectomies were analyzed. 33 out of 77 cases were group A, 44 out of 77 were group B. The mean length of stay were 7. 12 days, 8. 20 days group A and group B respectively. There are significant differences ( P < 0. 05) , The average total expenses were 9495. 76 and 12348. 37 RMB in the group A and group B respectively, there was significant difference ( P >0. 05 ) between them. Comparing the constituents of the two groups, expenses for medicine, cost for anesthesia have significant difference ( P<0. 05) , Expenses for medicine and cost for anesthesia in group B are higher than group A, The reason is that patients in group B stayed longer time in hospital. Conlusions The group whose clinical pathway was designed according to our hospital situation had short length of hospital stay than the group whose clinical pathway was announced by the Ministry of Health in 2009, significant difference was found between the cost of hospitalization.