基于临床路径的原发性肝癌肝切除术和热消融术诊疗过程质量研究

Study on the process quality of medical care among inpatients with primary hepatic carcinoma undergoing hepatectomy and thermal ablations according to national clinical pathway

目的分析上海市公立三级甲等综合医院肝切除和热消融治疗原发性肝癌住院诊疗的临床路径实施与符合状况。方法在上海市抽取3所公立三级甲等综合医院2016—2017年符合第一诊断为原发性肝癌且行肝切除术或热消融术的出院病案247份,进行病案评阅,分析诊疗过程与临床路径要求的符合情况。结果上海市3所公立三级甲等综合医院原发性肝癌肝切除术和热消融术的临床路径平均符合率分别为54.72%和47.98%,肝切除术和热消融术的选择符合率分别为88.81%和65.49%,及时与恰当的术前与术后检查符合率较低。结论需推动原发性肝癌肝切除术的临床路径实施,加快制定原发性肝癌热消融术的临床路径,提高术前与术后检查的符合率,更多关注预防性抗菌药物的合理使用。

Objective To analyze the compliance of medical care according to national clinical pathway among inpatients with primary hepatic carcinoma(PHC)undergoing hepatectomy and thermal ablations in public class-A tertiary general hospitals in Shanghai.Methods A total of 247 inpatients with PHC undergoing hepatectomy or thermal ablations admitted in 2016 and 2017 were sampled from three public class-A tertiary general hospitals.Medical charts were reviewed to estimate the compliance of the diagnosis and treatment procedure of hepatectomy and thermal ablation according to national clinical pathway.Results The average overall compliance rates was 54.72%for hepatectomy and was 47.89%for thermal ablations.The compliance rate of appropriate therapy selection was 88.81%for hepatectomy and was 65.49%for thermal ablations.The compliance rates for timely and appropriate tests and examinations before and after hepatectomy or thermal ablations were relatively low.Conclusion The implementation of clinical pathway for hepatectomy should be improved.The clinical pathway of PHC’s thermal ablations should be formulated urgently.In addition,the compliance rate of appropriate therapy selection for hepatectomy and thermal ablations should be increased,and the appropriate use of prophylactic antibiotics deserve more attention.