广西某三级甲等医院10个病种的临床路径实施效果评价

Effect evaluation of clinical pathway of 10 diseases in a tertiary hospital in Guangxi

目的了解广西某三级甲等医院10个病种临床路径的实施效果。方法选取该医院2018年1月至6月期间新开展临床路径的10个病种,将病种实施临床路径前1年内的病例作为对照组,实施临床路径后1年内进入并完成临床路径的病例作为路径组,比较2组的住院天数、住院费用和疾病转归等指标。结果路径组共纳入1133例,对照组共纳入914例。路径组的住院天数、总费用和药占比均小于对照组,治疗有效率高于对照组,差异均有统计学意义(P<0.05)。部分病种在实施临床路径后某些指标未达到预期效果,脑缺血性疾病病种的路径组住院天数和药占比均大于对照组;包茎或包皮过长日间手术病种的路径组总费用高于对照组;轻型颅脑损伤和输尿管内支架病种的路径组药占比均高于对照组;精神分裂症和颈部肿物日间手术病种的路径组材料占比均大于对照组,差异均有统计学意义(P<0.05)。结论该医院实施临床路径取得了一定成效,但仍存在部分问题有待改善。医院可采取针对性的改进措施,完善临床路径的相关制度流程。

Objective To evaluate the implementation effect of clinical pathways of 10 diseases in a tertiary hospital in Guangxi.Methods Ten diseases of new clinical pathways from January to June 2018 were selected,and the cases within the previous year of the implementation of clinical pathway were put into the control group,and the cases within one year after the implementation of the clinical pathway were put into the pathway group.The hospitalization days,hospitalization expenses,and disease outcomes of the two groups were compared.Results Totally 1133 cases were included in the pathway group and 914 cases were included in the control group.The hospitalization days,total expenses and drug proportion in the pathway group were smaller than those in the control group,and the treatment efficiency in the pathway group was higher than that in the control group,with the differences statistically significant(P<0.05).Some indexes of diseases did not achieve the expected effects after the clinical pathway was implemented.The hospitalization days and drug proportion in the pathway group of cerebral ischemic diseases were higher than those in the control group,the total expenses of the pathway group of the phimosis day surgery were larger than that of the control group,the drug proportion of the pathway group of the craniocerebral injury and ureteral stent was higher than that of the control group,the material proportion of the pathway group of schizophrenia and cervical masses day surgery was larger than that of the control group,and the differences were statistically significant(P<0.05).Conclusion The hospital has achieved certain results in implementing the clinical pathway,but some problems still need to be improved.The hospital can take targeted improvement measures to improve the relevant processes of the clinical pathway.