期刊文献+

实施临床路径管理前后全髋关节置换术住院费用的对比研究 被引量:16

Analyzing the impact of applying clinical pathway on the hospitalization costs of total hip replacement
原文传递
导出
摘要 目的 探讨临床路径管理对控制住院费用的作用,为合理控制医疗费用提供依据.方法 对2005年和2010年在北京大学人民医院骨关节中心接受全髋关节置换术患者的住院费用进行回顾性分析.2005年和2010年分别有84例患者和219例患者纳入研究.2005年单侧全髋关节置换和双侧全髋关节同时置换分别为70例、14例,2010年单侧全髋关节置换和双侧全髋关节同时置换分别为173例、46例.总住院费用包括床位费、护理费、化验检查费、假体耗材费、输血费、手术费、药品费、治疗费、诊疗费共9项,比较2005年与2010年总住院费用及各项住院费用.结果 2005年单侧全髋和双侧全髋关节同时置换病例的年龄、性别与2010年比较差异无统计学意义,2005年与2010年病例原发疾病种类及使用假体类型的差异无统计学意义.2010年单侧全髋关节置换术总住院费用为40 852.72元,双侧全髋关节同时置换术为73 020.28元,总住院费用较2005年(分别为49 371.35、80 962.61元)下降,差异有统计学意义.2010年全髋关节同时置换术各项住院费用分别为585.88、145.38、2 885.47、3 222.32、1 776.15、3 805.29、132.79、4 100.88、30 953.75元,较2005年下降,差异有统计学意义.其中手术费、治疗费、诊疗费和床位费下降最为明显,分别下降了35.11%、31.76%、31.40%和30.67%.单侧全髋与双侧全髋关节同时置换病例各项费用的变化趋势与总体费用相似.结论 2010年全髋关节置换术总住院费用较2005年降低,可能主要与科室从2010年起施行临床路径管理有关.在各项住院费用中,假体耗材费所占比例最大,控制假体耗材费是降低全髋关节置换术住院费用的有效手段. Objective To analyze the role of Clinical Pathway in controlling hospitalization cost and to provide the basis for reasonable control of medical cost.Methods The data of patients undergoing unilateral and bilateral total hip replacement in 2005 and 2010 in Arthritis Clinical and Research Center of Peking University People's Hospital were retrospectively analyzed.There were 70 unilateral and 14 bilateral total hip replacement cases in 2005,whereas the number of those in 2010 was 173 and 46 respectively.All charges were assigned to 1 of 9 categories:hospital room,nursing,radiology and laboratory,prosthesis,blood transfusion,surgery,pharmacy,treatment,diagnosis.We compared the total costs and cost of each category between 2005 and 2010.Results There was no statistical significant difference between 2005 and 2010 in terms of age,gender distribution,pri mary disease and type of prosthesis.The total costs for unilateral and bilatcral total hip replacement was 40 852.72 yuan and 73 020.28 yuan in 2010,respectively.They were both significantly lower than those of 2005 (49 371.35 yuan and 80 962.61 yuan respectively).The charge for each category of total hip replacement in 2010 was 585.88,145.38,2 885.47,3 222.32,1 776.15,3 805.29,132.79,4 100.88,and 3 0953.75 yuan.Compared with 2005,each category of charge dropped in 2010,especially the cost of surgery,treatment,diagnosis and hospital room,which decreased by 35.11%,31.76%,31.40% and 30.67% respectively.The tendency of each category change in charge of unilateral and bilateral total hip replacement was similar to the overall costs.Conclusion The total costs for total hip replacement (unilateral and bilateral total hip replacement) in 2010 were lower than those of 2005,which might be the result of adopting Clinical Pathway since 2010.Nevertheless,the prosthesis cost accounted for a large proportion in both years.Therefore,controlling the prosthesis cost might be an effective way to reduce medical costs for total hip replacement.
作者 王锴 林剑浩
出处 《中华骨科杂志》 CAS CSCD 北大核心 2014年第6期612-618,共7页 Chinese Journal of Orthopaedics
关键词 费用 医疗 关节成形术 置换 临床路径 Fees, medical Arthroplasty, replacement, hip Clinical pathways
  • 相关文献

参考文献12

  • 1Ethgen O,Bruyere O,Richy F,et al.Health related quality of life in total hip and total knee arthroplasty: A qualitative and systematic review of the literature[J].J Bone Joint Surg Am,2004,86(5): 963-974.
  • 2Rasanen P,Paavolainen P,Sintonen H,et al.Effectiveness of hip or knee replacement surgery in terms of quality-adjusted life years and costs[J].Acta Orthop,2007,78(1): 108-115.
  • 3Jones CA,Beaupre LA,Johnston DW,et al.Total joint arthroplasties: current concepts of patient outcomes after surgery[J].Rheum Dis Clin North Am,2007,33(1): 71-86.
  • 4Kurtz S,Ong K,Lau E,et al.Projections of primary and revision hip and knee arthroplasty in the United States from 2005 to 2030[J].J Bone Joint Surg Am,2007,89(4): 780-785.
  • 5中华人民共和国卫生部.临床路径管理指导原则(试行).2009,http://www.moh.gov.cn/zwgkzt/lclj/201306/1067154511a34 95285d805592586159b.shtml.
  • 6北京市统计局,国家统计局背景调查总队,编.北京市统计年鉴.http://www.bjstats.gov.cn/nj/main/2011-tjnj/index.htm.
  • 7中华人民共和国卫生部,国家中医药管理局,总后卫生部.抗菌药物临床应用指导原则.http://www.sfda.gov.cn/WS01/CL0056/10752.html,2004-08-19/2010-06-15.
  • 8中国骨科大手术静脉血栓栓塞症预防指南[J].中华骨科杂志,2009,29(6):602-604. 被引量:530
  • 9骨科常见疼痛的处理专家建议[J].中华骨科杂志,2008,28(1):78-81. 被引量:211
  • 10中华人民共和国卫生部.临床输血技术规范.卫医发[2000]184号.http://www.moh.gov.cn/publicfiles/business/htmlfiles/mohyzs/s3589/200804/18676.htm.

二级参考文献45

  • 1林剑浩,吕厚山.预存自体输血在风湿病手术中的应用[J].中华外科杂志,1993,31(9):542-544. 被引量:16
  • 2邱贵兴,杨庆铭,余楠生,翁习生,王凯,李晓林.低分子肝素预防髋、膝关节手术后下肢深静脉血栓形成的多中心研究[J].中华骨科杂志,2006,26(12):819-822. 被引量:428
  • 3Ollendorf DA,Vera-Llonch M,Oster G.Cost of venous thromboembolism following major orthopedic surgery in hospitalized patients.Am J Health Syst Pharm,2002,59(18):1750-1754.
  • 4Geerts WH,Pineo OF,Heir JA,et al.Prevention of venous thromboembolism:the Seventh ACCP Conference on Antithromboric and Thrombolytic Therapy.Chest,2004,126 (3 Suppl):S338-400.
  • 5Mosby's Dictionary of Medicine,Nursing & Health Professions.7th ed.St.Louis,MO:Mosby,2006:115-116,335,520,1454,1849,1949.
  • 6Piovella F,Wang CJ,Lu H,et al.Deep-vein thrombosis rates after major Orthopedic surgery in Asia:an epidemiological study based on postoperative screening with centrally adjudicated bilateral venography.J Thromb Haemost,2005,3(12):2664-2670.
  • 7Heir JA,O'Fallon WM,Petterson TM,et al.Relative impact of risk factors for deep vein thrombosis and pulmonary embolism:a population-based study.Arch Intern Med,2002,162 (11):1245-1248.
  • 8Anderson FA Jr,Spencer FA.Risk factors for venous thrombcembolism.Circulation,2003,107(23 Suppl 1):9-16.
  • 9Caprini JA.Thrombosis risk assessment as a guide to quality patient care.Dis Mon,2005,51(2/3):70-78.
  • 10Geerts WH,Heit JA,Clagett GP,et al.Prevention of venous thromboembolism.Chest,2001,119(1 Suppl):S132-175.

共引文献772

同被引文献132

  • 1中华医学会外科学分会疝和腹壁外科学组.成人腹股沟疝、股疝和腹部手术切口疝手术治疗方案(2003年修订稿)[J].中华外科杂志,2004,42(14):834-835. 被引量:630
  • 2郝清云.临床路径在慢性阻塞性肺疾病康复护理中的实践[J].国际护理学杂志,2007,26(6):606-607. 被引量:1
  • 3姚蕴伍,沈雅芳,胡斌春.护理管理与临床护理技术规范[M].杭州:浙江大学出版社,2004.336-541.
  • 4刘佳.骨科老年患者术后认知功能障碍的原因分析及护理[J].中国实用护理杂志,2014,30(z1):47.
  • 5Ohashi K. Effects of early morning care,named "Comfort upon Rising" care, on postoperative orthopedic ambulation and morning activity [J]. Jpn J Nurs Sci,2014,11 (4):268- 280.
  • 6Maher DP, Kissen M, Danoviteh I,et al. Pefioperative sub- stance use disorder,opioid diversion,and opioid misuse by a medical professional undergoing orthopedic surgery [J]. J Opioid Manag, 2014,10(6) :437-440.
  • 7Silva MB,Almeida Mde A,Panato BP,et al. Clinical ap- plicability of nursing outcomes in the evolution of ortho- pedic patients with impaired physical mobility [J] .Rev Lat Am Enfermagem, 2015,23 ( 1 ) : 51-58.
  • 8Garimella R,Washington L,Isaacson J, et al. ExtraceUu- lar membrane vesicles derived from 143b osteosarcoma cells contain pro-osteoclastogenic cargo: a novel com- munication mechanism in osteosarcoma bone microenvi- ronment [J]. Transl Oncol, 2014,7 (3) : 331-340.
  • 9Imbelloni LE,Gomes D, Braga RL, et al. Clinical strate- gies to accelerate recovery after surgery orthopedic femur in elderly patients [J].Anesth Essays Res,2014,8(2) : 156- 161.
  • 10黎介寿.对Fast-track surgery内涵的认识[J].中华普外科手术学杂志(电子版),2007,1(1):1-2. 被引量:28

引证文献16

二级引证文献124

相关作者

内容加载中请稍等...

相关机构

内容加载中请稍等...

相关主题

内容加载中请稍等...

浏览历史

内容加载中请稍等...
;
使用帮助 返回顶部