三级甲等医院儿科支气管肺炎临床路径执行情况全国多中心研究

Multicenter research on the compliance of clinical pathway of bronchopneumonia in pediatrics of tertiary class A hospitals

目的评价支气管肺炎临床路径的入组率、变异率及原因。方法回顾性收集首都医科大学附属北京儿童医院2012年1月至2016年12月施行临床路径5年来各年入组率、完成率、变异及变异原因。采用问卷调查的方法,收集三级甲等医院儿科实施支气管肺炎临床路径后的相关数据,以分析入组率、完成率、变异及相关原因。结果1.至2016年底,纳入研究的13家医院中11家医院施行临床路径达5年,1家施行3年,1家施行2年。2.11家外院提供了入组率,实施临床路径来入组率<50%的有2家医院,入组率>80%的有9家医院。北京儿童医院各年完成率≥75%,提供了数据的8家外院完成率基本>70%。3.北京儿童医院实施临床路径5年以来总计入组427例,变异93例(变异率21.78%)。外院有5家医院从实施临床路径来变异率即保持在<15%的水平;3家医院随实施年限增加变异率逐年下降,由不合格到合格;1家医院先反弹后控制;1家医院变异率增加27.65%;1家医院变异率先控制后反弹;1家医院变异率始终>15%。变异的最主要原因为合并症、并发症、病情进展或入院后修正第一诊断等疾病因素。结论各地完成率均达到要求,入组率有待提高,变异率差异大,临床路径的推行需加强监控及进一步优化。

Objective To evaluate the enrollment rate,mutation rate and causes of variability the clinical pathway of bronchopneumonia.Methods The enrollment rate,completion rate,variation and reasons of the clinical pathway in Beijing Children′s Hospital,Capital Medical University from January 2012 to December 2016 were retrospectively collected.Data of patients after the clinical pathway of bronchopneumonia in other tertiary class A hospitals were gathered by questionnaires,and the enrollment rate,completion rate,variation rate and reasons were analyzed.Results(1)At the end of 2016,11 of the 13 hospitals included in this study had implemented the clinical pathway for 5 years,1 hospital for 3 years,and 1 hospital for 2 years.(2)Eleven hospitals provided their enrollment rates.The enrollement rate of 2 hospitals was<50%,and that of 9 hospitals was>80%.The annual completion rate of Beijing Children′s Hospital was≥75%,and the completion rates offered by 8 hospitals were basically>70%.(3)Since the implementation of the clinical pathway for 5 years in Beijing Children′s Hospital,a total of 427 cases were enrolled of which 93 cases were mutated(variability 21.78%).The variability of 5 hospitals was maintained at<15%.The variability of 3 hospitals decreased with the implementation years,and became qualified.The variability of 1 hospital first rebounded and then controlled;1 hospital increased by 27.65%;1 hospital was first controlled and rebounded;1 hospital was always>15%.The main cause of the mutation was coexisting diseases,complications,progression of the disease,or correction of the first diagnosis,etc.Conclusions The completion rate of tertiary class A hospitals meets the requirements of national policy.However,the enrollment rate needs to be improved,and the variation rate among different hospitals differs a lot.Further implementation of the clinical pathway should be strengthened and monitored.