基于潜在类别分析的差异化临床路径管理对策研究

Study on differentiated strategy of clinical pathway management based on latent class analysis

目的通过对某医院临床路径病种进行类别划分,制定差异性临床路径管理对策,使得临床路径管理更精细,改善临床路径实施效果。方法以某医院2021年1月1日至2023年8月30日306个临床路径病种入径率、完成率、死亡率、治愈率、好转率、再入院率、变异率、平均住院日、平均住院费用为资料,采用潜在类别分析(LCA)进行临床路径病种分类,根据分类结果制定管理对策。结果306个临床路径病种最终划分为3个潜在类别,分别命名为“慢性疾病-待改善病组”(152种)、“可治愈疾病-运行良好病组”(108种)和“可治愈疾病-管理不良病组”(46种)。对待改善病组优化路径阶段项目,管理不良病组给予“临床路径+疾病诊断相关分组(DRG)”联合管理模式,从而改善某医院临床路径实施效果。结论潜在类别分析能够综合分析多个评价指标将临床路径科学分类,按照类别精准施策,提升临床路径的管理效率。

Objective To develop the differentiated strategies of clinical pathway management by categorizing clinical pathway diseases in a hospital for refining clinical pathway management and improving the implementation outcomes.Methods The data of 306 clinical pathway diseases from January 1,2021 to August 30,2023 were collected,including pathway approach rate,completion rate,mortality rate,cure rate,improvement rate,readmission rate,variation rate,average hospital stay,and average hospitalization cost.Latent class analysis(LCA)was conducted to classify the clinical pathway diseases.Management strategies were then formulated based on the classification results.Results The 306 clinical pathway diseases were ultimately divided into three latent classes,named"Chronic Diseases-Being Modified Group"(152 types),"Curable Diseases-Well-Running Group"(108 types),and"Curable Diseases-Poorly Managed Group"(46 types).In order to improve the efficiency of clinical pathway management,the items of the clinical pathway were optimized for Chronic Diseases-Being Modified Group,and the clinical pathway combined with diagnosis related group(DRG)was chosen as compositive management model for Curable Diseases-Well-Running Group.Conclusion Latent class analysis can scientifically categorize the clinical pathway by comprehensively analyzing the multiple indicators,so the precise strategies can be implemented according to the research results to improve the efficiency of clinical pathway management.