我国中西医临床路径的疾病谱对比分析

The Analysis of Disease Spectrum of Traditional Chinese and Western Medicine Clinical Pathways in China

目的分析目前我国中西医临床路径的疾病谱覆盖情况。方法获取截止2019年5月国内已经颁布的中西医临床路径,由2名研究者独立提取资料,包括中西医路径名称、发布时间、关注疾病等,并采用《疾病和有关健康问题的国际统计分类第十次修订本》(ICD-10)编码对临床路径涉及疾病进行标引和分类。对于中医临床路径,同时采用《中医病证分类与代码》(TCD)中医病证编码对疾病进行标引和分类。采用描述性统计方法对中西医临床路径发布时间和疾病谱覆盖情况进行分析。结果2009—2017年共发布1212个西医临床路径,依据ICD-10分类标准,覆盖疾病系统种类20类;2010—2018年共发布405个中医临床路径,涉及疾病种类18类,按照TCD代码对中医临床路径进行归类,共涉及7种疾病分科。已颁布的西医临床路径数量远高于中医临床路径,但在疾病种类覆盖方面存在交叉,存在部分中医临床路径并未发现关于同疾病的西医临床路径。结论整体中西医临床路径发布年份的时间节点较为一致,不存在中医临床路径远滞后于西医临床路径的问题。未来在制定路径病种选择时应结合中医优势病种、路径空白疾病领域以及当前路径质量等方面综合考量。

Objective To investigate the disease spectrum of currently published traditional Chinese and Western medicine clinical pathways in China.Methods The clinical pathways published before May 2019 were obtained.Two authors independently extracted the basic characteristics of clinical pathways including title,involved disease,publication institution,and publication date.Two authors classified the traditional Chinese and Western medicine clinical pathways according to ICD-10 and TCD system.Descriptive analysis method was used to analyze the publication trend and disease spectrum.Result Totally 1212 Western medicine clinical pathways were published from 2009 to 2017,involving 20 disease systems based ICD-10 classification,while 405 Chinese medicine clinical pathways were published from 2010 to 2018,involving 18 disease systems.Based on TCD system,7 disease systems were involved.The number of Western medicine clinical pathways was higher than Chinese medicine clinical pathways,however,there were some Chinese medicine clinical pathways but no Western medicine pathways for the same disease.Conclusions Generally,the publication time trend was similar for traditional Chinese clinical pathways and Western clinical pathways.Considering the disease spectrum covered by current clinical pathways,future clinical pathways should focus on dominant diseases of traditional Chinese medicine,the blank field,and the quality assessment.