某试点医院慢性阻塞性肺疾病临床路径实施效果评价

The evaluation of implementation effect of clinical pathway in patients with chronic obstructive pulmonary disease

目的探索真实世界中临床路径在慢性阻塞性肺疾病患者中的实施效果。方法回顾性分析某试点医院2013-2017年收治的慢性阻塞性肺疾病患者资料。根据纳排标准,纳入临床路径组患者1337例,非临床路径组764例,采用1∶1倾向评分匹配法平衡组间基本资料不均衡的变量并获得匹配患者,分析比较两组患者住院天数、医疗费用、出院转归情况。结果采用倾向性评分匹配后两组各获得727例患者,临床路径组患者住院天数、住院总费用、分项费用中护理费、床位费、西药费、诊疗费明显少于非临床路径组(P<0.05),临床路径组患者的好转率高于非临床路径组,死亡率低于非临床路径组(P<0.05)。结论慢性阻塞性肺疾病患者实施临床路径后能明显地缩短住院时间、节约医疗费用、改善患者病情,因此临床路径在慢性阻塞性肺疾病中具有一定的应用价值。

Objective To investigate the implementation effect of clinical pathway in patients with chronic obstructive pulmonary disease in the real world.Methods The data of COPD patients admitted to a pilot hospitalfrom 2013 to 2017 was retrospectively analyzed.According to the inclusion and exclusion criteria, 1337 patients were included in the clinical pathway group and 764 patients in the non clinical pathway group.The 1∶1 propensity score matching method was used to balance the variables of basic data imbalance between the two groups and obtain matched patients.To analyze and compare the hospitalization days, medical expenses, and discharge outcomes of the two groups.Results 727 patients in each group were obtained after using propensity score matching.The hospitalization days, total hospitalization expenses, nursing expenses, bed expenses, western medicine expenses and diagnosis and treatment expenses in the clinical pathway group were significantly less than those in the non clinical pathway group(P<0.05),The improvement rate of the patients in the clinical pathway group was higher than that in the non clinical pathway group, and the mortality rate was lower than that in the non clinical pathway group(P<0.05).Conclusion After the implementation of clinical pathway, patients with COPD can significantly shorten hospitalization days, save medical costs and improve patients′ condition, so the clinical pathway has certain application value in COPD.