DRGs背景下CAP中医临床路径实施效果研究

Research on the implementation effect of TCM clinical pathway for CAP under the background of DRGs

目的 研究在疾病诊断相关分组(diagnosis related groups,DRGs)医保支付方式改革背景下,实施非重症社区获得性肺炎(community acquired pneumonia,CAP)中医临床路径对疗效及卫生经济学指标的影响。方法 选择2019年1月至2020年12月丽水市中医院呼吸与危重症医学科住院的CAP患者200例,采用随机数字表法分为对照组(未纳入中医临床路径组)和观察组(纳入中医临床路径组),每组各100例;观察组执行CAP中医临床路径方案,对照组根据医护人员临床经验和习惯诊疗。观察两组患者治疗前后的咳嗽、咳痰症状积分和白细胞计数(white blood cell count,WBC计数)、血清C反应蛋白(C-reactive protein,CRP)变化,比较两组平均住院日、住院费用等卫生经济学指标。结果 两组患者的咳嗽、咳痰症状积分分别较治疗前明显降低,且观察组患者的咳嗽、咳痰症状积分分别明显低于对照组(P<0.05)。观察组患者的外周血WBC计数和CRP水平分别明显低于对照组(P<0.05)。观察组患者的住院费用、平均住院日较2018年下降(P<0.01),费用消耗指标、时间消耗指标均小于1。对照组住院费用较2018年下降(P<0.05),费用消耗指标小于1;对照组住院日与2018年比较,差异无统计学意义(P>0.05),时间消耗指标大于1。结论 实施CAP中医临床路径可明显改善疗效,降低住院费用和住院日,规范抗菌药物应用,实现费用消耗指标、时间消耗指标双优化,可有效提升医疗质量、降低医疗成本。

Objective To study the implementation effect of TCM clinical pathway for non-severe community-acquired pneumonia(CAP) on curative effect and health economic indicators under the background of medical insurance payment mode reform based on diagnosis related groups(diagnosis related groups, DRGs). Methods Two hundreds CAP patients were selected from January 2019 to December 2020, the observation group implemented the CAP TCM clinical pathway plan, while the control group was treated according to the clinical experience and habits of medical staff. Cough and sputum symptom scores,blood routine and serum C-reactive protein(C-reactive protein, CRP) changes were observed before and after treatment in two groups, and health economic indicators such as average hospital stay, and hospitalization cost were compared between two groups. Results The scores of cough and expectoration symptoms in the two groups were significantly lower than those before treatment, and the scores of cough and expectoration symptoms in the observation group were significantly lower than those in the control group(P<0.05). The WBC count and CRP level in the observation group were significantly lower than those in the control group(P<0.05). The hospitalization expenses and average hospitalization days of patients in the observation group decreased compared with 2018(P<0.01), and the expense consumption index and time consumption index were all less than 1.The hospitalization expenses in the control group decreased compared with that in 2018(P<0.05), and the cost consumption index was less than 1;There was no significant difference between the hospital stay of the control group and that of 2018(P>0.05), the time consumption index was greater than 1. Conclusion The implementation of CAP TCM clinical pathway can significantly improve the curative effect, reduce the hospitalization cost and hospital stay, standardize the application of antibacterial drugs,realize the double optimization of cost consumption index and time consumption index, effectively improve the medical quality and reduce the medical cost.