某医院进行临床路径信息化改造和优化的效果分析

Effect of information based transformation and optimization of clinical pathway in a hospital

目的为促进临床路径信息化高效而且广泛的应用、发挥临床路径作为医疗质量控制与管理工具的作用、保障医疗安全、提高医疗服务质量同质化水平提供参考依据。方法对信息化临床路径进行重新设计规划,以新的运行模式重构临床路径信息化关键节点,并加入路径执行率实时指标,逐步实现监管信息化。结果临床路径病种由2017年的78种增加到2018年5月份的328种;2018年1—5月电子路径完成人数占全院出院人数比例接近50%;遴选的9个病种平均住院日、人均费用、人均药费、药比均下降的4个病种(取除骨折内固定装置、鼻骨骨折、输尿管结石、大肠息肉)2.0版路径与非电子路径比较均有统计学差异(P<0.05)。结论规范的电子路径在很大程度上缩短了平均住院日、减少了医疗费用、规范了医疗行为,在未来的医院管理中将发挥更大作用。

Objective To promote the efficient and extensive application of clinical pathway information,to play the role of clinical pathway as a medical quality control and management tool,to ensure medical security,to improve the homogenization level of medical service quality,and to gradually improve proportion clinical pathway discharges accounting for over 50%of the total number of hospital discharges.Methods Information based clinical pathway was redesigned,in the mean time,key nodes of the information based clinical pathway were reconstructed under new operational mode,real-time indicators of the pathway execution rate were added,and as a result,complete information based supervision was gradually realized.Results The number of demographics of diseases under clinical pathway increased from 78 categories in 2017 to 328 categories in May 2018.The population of digital clinical pathway completed accounted for nearly 50%of the hospital discharges from January to May 2018.Four diseases(removal of internal fixation device of fracture patients,nasal fracture,ureteral calculi,and large intestine polyps)were selected out of 9 diseases for the decrease in average hospitalization period,average expense per head,average pharmaceutical expense per head,and average pharmaceutical percentage.The 2.0 version of the clinical pathway was statistically different from the non-digital clinical pathway(P<0.05).Conclusion The standardized digital clinical pathway has shortened the average hospitalization period to a large extent,reduced medical expenses,standardized medical treatment to the greatest extent,and will play a greater role in future hospital management.