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目的本研究旨在通过比较某三级甲等综合医院实施临床路径前后的5个病种相关指标的分析,评估临床路径在该院的实施状况及其效果,为医疗机构实施和推广临床路径提供一定的实践依据。方法主要选取住院人次较多、诊断明确、治疗有效、手术或诊疗差异较小的5个病种,采用回顾性调查方法,利用医院信息科电子病历系统,选择2011年6月至2012年12月实施临床路径的病例作为路径组,选择在2009年6月至2010年12月未实施临床路径的相应病例作为对照组,统计两组病例的住院费用、药品费用、住院天数等情况,并进行分析比较。结果实施临床路径后的腹股沟疝、老年性白内障、胎膜早破、下肢静脉曲张及声带息肉路径组患者平均住院日均少于对照组患者,差异具有统计学意义(P<0.05);实施临床路径后的腹股沟疝、老年性白内障和胎膜早破路径组患者平均住院费用及平均药费均低于对照组患者,差异具有统计学意义(P<0.05);实施临床路径后的声带息肉路径组患者平均住院费用及平均药费均高于对照组患者,差异具有统计学意义(P<0.05);下肢静脉曲张路径组和对照组平均住院费用以及平均药费的比较,差异不具有统计学意义(P>0.05)。结论该医院实施临床路径的5个病种可以缩短病人的平均住院日,降低医疗成本,提高病床周转率,促进医院资源的有效利用,部分病种降低了患者的平均住院费用和平均药费,减少了不合理药物的使用,减轻了患者经济负担。部分病种尚未体现降低患者平均住院费用和平均药费的效果,甚至有所增加。
Objectives The purpose of this study is to compare the status of clinical pathways in the hospital and its effectiveness by comparing the five disease-related indicators before and after the implementation of a clinical pathway in a tertiary A general hospital to provide a guideline for the implementation and promotion of clinical pathways by medical institutions A certain practical basis. Methods Five inpatients with more inpatients, more definite diagnosis, effective treatment and less difference in operation or diagnosis were selected. The retrospective survey method was used to select the electronic medical records system from June 2011 to December 2012 The cases of clinical pathways were selected as the path group, and the corresponding cases without clinical pathways between June 2009 and December 2010 were selected as the control group. The hospitalization expenses, drug costs, hospitalization days and so on were calculated and analyzed Compare Results The average length of hospital stay of inguinal hernia, senile cataracts, premature rupture of membranes, varicose veins of the lower extremities and vocal cord polyp pathology group were less than those of the control group after the implementation of the clinical pathway. The difference was statistically significant (P <0.05) The average cost of hospitalization and the average cost of patients with inguinal hernia, senile cataract and premature rupture of membranes group were lower than those of the control group (P <0.05). The path of vocal cord polyp The average hospitalization cost and average drug cost of the patients in the group were higher than those in the control group, the difference was statistically significant (P <0.05). There was no statistical difference between the average hospitalization expense and the average drug cost in the varicose vein group and the control group Significance (P> 0.05). Conclusion The five clinical trails of the hospital can shorten the average length of stay of patients, reduce the cost of medical treatment, improve the turnover rate of hospital beds and promote the effective utilization of hospital resources. Some of the diseases reduce the average cost of hospitalization and average medical expenses of patients, Reduce the use of unreasonable drugs, reducing the financial burden on patients. Some diseases have not yet reflected the effect of reducing the average hospitalization costs and the average cost of drugs, and even increased.