急性ST段抬高型心肌梗死临床路径实施效果评价

Evaluation of clinical pathway implementation of acute ST-segment elevation myocardial infarction

目的探讨急性ST段抬高型心肌梗死(acute ST segment elevation myocardial infarction,STEMI)患者应用临床路径管理的效果。方法回顾分析重庆市某三级甲等医院2011年8月-2018年8月就诊的心肌梗死患者资料,根据纳入标准,纳入临床路径患者51例,非临床路径患者53例。采用1∶1倾向评分匹配(propensity score matching,PSM)控制混杂因素,确保临床路径组和非临床路径组患者在人口学基线无统计学差异,以保证组间可比性。结果临床路径组住院天数、总费用、自付费用、各分项费用中床位费、西药费、检验费低于非临床路径组,差异无统计学意义(P>0.05);分项费用中的护理费和放射费高于非临床路径组,且差异无统计学意义(P>0.05)。结论STEMI临床路径的实施可以降低住院时间、总费用、床位费、西药费和检验费。本研究样本量相对较少,有一定的局限性,建议做更多有关STEMI患者实证研究检验临床路径效果。

Objective To explore the effect of clinical pathway on patients with acute ST segment elevation myocardial infarction(STEMI)using the data of patients in pilot medical institutions.Methods The data of patients with myocardial infarction in a tertiary hospital in Chongqing from August 2011 to August 2018 were retrospectively analyzed.According to the inclusion criteria,51 patients with clinical pathway and 53 patients with non-clinical pathway were included.1:1 propensity score matching(PSM)was used to control confounding factors to ensure that there was no statistical difference between the demographic baseline between the clinical pathway group and the non-clinical pathway group.Therefore,there was comparability between groups.Results In the clinical pathway group,the length of stay,the total cost of hospitalization for a single visit,the out-of-pocket cost,bed fee,western medicine fee and the examination fee were lower than those in the non-clinical pathway group.There was no significant difference(P>0.05).But the costs of nursing and radiation were higher than that of non-clinical pathway group,and there was not significant difference(P>0.05).Conclusion The implementation of the clinical pathway of acute ST-segment elevation myocardial infarction can reduce the length of hospitalization,total cost,bed fee,western medicine fee and inspection fee.The sample size of this study is relatively small and has certain limitations.It is recommended to conduct more empirical research to test the effect of clinical pathways.