基于DRGs的临床路径实施与质量评价研究

Study on Clinical Pathway Implementation and Quality Evaluation Based on DRGs

目的应用DRGs相关评价指标评估杭州市某三甲综合医院临床路径实施效果,并建立科室临床路径实施质量评价模型。方法将该院2017年可纳入临床路径管理的病例按是否完成出径分为cp组和非cp组,分别计算全院及各科室的效率指标和医疗质量指标,采用独立样本t检验和χ2检验进行统计学分析,评价实施效果。以药占比为参考指标,以效率指标为比较指标,采用灰色关联分析计算各指标的权重,计算加权得分,评价科室临床路径实施质量。结果完成临床路径可显著降低出院病例的时间指数、费用指数、药品指数(p<0.05或p<0.001),提高治愈好转率,降低病死率(p<0.001)。该院2017年临床路径实施质量综合得分排名前5的科室是A28、A24、A18、A14和A21;影响临床路径病种药占比的关键指标依次是管理率、完成率、入径率、药品指数、费用指数、时间指数。结论本研究建立了一套客观、可量化又相对完整的临床路径质量评价标准,有助于发现不同阶段的重点干预环节,实现临床路径质量的动态监管和持续改进。

Objective To assess the effect of the clinical pathway practice in the hospital using DRG-related evaluation indicators and establish a quality evaluation model for clinical pathway implementation in the department.Methods The cases that could be included in clinical pathway management of the hospital in 2017 were divided into two groups based on clinical pathway execution status,including cp group and non-cp group.Independent sample t-test and chi-square test were conducted to compare differences of the efficiency parameters and medical quality indicators of the whole hospital and different departments to evaluate the implementation effect.Taking the drug proportion for reference and efficiency indicators for comparison,the grey relational analysis was used to determine the weight coefficient of each indicator,calculate the total score and evaluate the clinical pathway implementation quality of each department.Results The completion of clinical pathway could significantly reduce the indicators for time,cost and drugs(p<0.05),improve the cure rate,and lower the fatality rate(p<0.001).The top five departments for comprehensive scores of the clinical pathway quality of the hospital in 2017 were A28,A24,A18,A14 and A21.The key indicators for drug proportion were successively management rate,completion rate,entry rate,drug indicator,cost indicator and time indicator.Conclusion The construction of an objective,quantifiable and comprehensive evaluation system in this study can contribute to identifying key intervention items in different stages and facilitate the dynamic regulation and continuous improvement of clinical pathway quality.