基于戴明循环优化儿童社区获得性肺炎中医临床路径的回顾性队列研究

Optimization of Traditional Chinese Medicine Clinical Pathway for Community Acquired Pneumonia in Children Based on Deming Cycle:A Retrospective Cohort Study

目的:评价戴明循环优化儿童社区获得性肺炎(CAP)中医临床路径的效果。方法:采用回顾性队列研究方法,通过电子病历系统收集2018年1月至2019年12月在山东中医药大学附属医院儿科住院并纳入儿童CAP中医临床路径的1646例患儿的病历资料。将实施2019年版临床路径(在2018年版基础上应用戴明循环进行了优化)诊疗方案的879例患儿设为暴露组,匹配实施2018年版临床路径诊疗方案的767例患儿为非暴露组。比较两组住院时间、住院费用、疗效、抗菌药物使用率、中药饮片使用率,评价应用戴明循环改进临床路径的效果。结果:暴露组患儿住院时间及住院总费用低于非暴露组,出院疗效分级情况优于非暴露组,中草药及中医特色疗法费用占比、中药饮片使用率均高于非暴露组,西药费用占比、抗菌药物使用率均低于非暴露组,差异均有统计学意义(P<0.05)。结论:应用戴明循环进行质控管理优化儿童CAP中医临床路径,可突出中医药优势,减少抗菌药的使用,缩短住院时间,降低住院费用,提高临床疗效。

Objective:To evaluate the effect of Deming cycle on optimizing traditional Chinese medicine(TCM)clinical pathway for community acquired pneumonia(CAP)in children.Methods:By the method of retrospective cohort study,the medical record data of 1646 children with CPA hospitalized in pediatrics department of the Affiliated Hospital of Shandong University of Traditional Chinese Medicine from January 2018 to December 2019 and included in the TCM clinical pathway of CAP were collected from the electronic medical record system.For comparison,879 children who implemented the diagnosis and treatment scheme of clinical pathway 2019(optimized by Deming cycle on the basis of clinical pathway 2018)were assigned to the exposed group,and 767 children implemented the diagnosis and treatment scheme of clinical pathway 2018 were assigned to the non-exposed group. The hospitalization time,hospitalization cost,curative efficacy,usage of antibacterial drugs,and usage of TCM decoction pieces of the two groups were compared,so as to evaluate the effect of Deming cycle on improving clinical pathway. Results:The hospitalization time and total hospitalization cost of the exposed group were lower than those of the non-exposed group. The curative efficacy classification of the children in the exposed group when they left hospital was better than that in the non-exposed group. The cost proportion of Chinese herbal medicine and therapies with TCM characteristics,and usage of TCM decoction pieces of the exposed group were higher than those of the non-exposed group,while the cost proportion of western medicine and usage of antibacterial drugs of the exposed group were lower than those of the non-exposed group. All the above differences were statistically significant(P<0.05). Conclusions:The application of Deming cycle in quality control management and optimization of TCM clinical pathway for CAP in children can highlight the advantages of TCM,reduce the usage of antibacterial drugs,shorten the length of hospitalization,reduce hospitalization cost,and improve the clinical curative efficacy.