摘要
目的对某院诊断为急性ST段抬高型心肌梗死患者的临床路径变异原因进行分析,进一步提高临床路径管理。方法利用系统抽样抽取2013年10月-2016年10月共601例符合急性ST段抬高型心肌梗死临床路径患者的信息,包括427例进入临床路径患者和174例退出路径的患者,并对资料进行回顾性分析,使用两独立样本t检验比较各统计学指标,分析导致路径变异的原因。结果 18类变异原因中排名第一的是患者发生并发症或合并症共21例,占12.2%;由于设备故障引起的变异例数最少,共3例,占1.7%。从变异类型来看,可避免的负性变异为99例,占56.9%;不可避免的负性变异为57例,占32.7%;正向变异18例占10.4%。变异组患者的平均住院日、平均住院费用均高于路径组患者,差异具有统计学意义。结论某院导致急性ST段抬高型心肌梗死临床路径发生变异的主要因素是诊疗流程的不合理,加强临床路径管理优化诊疗流程可以减少变异的发生。
Objectives To analyze the causes of clinical pathway variation in a hospital diagnosed with acute ST segment elevation myocardial infarction, and further improve the clinical pathway management. Methods The use of SYS sampling in 601 patients, including 427 cases of patients and 174 cases of the clinical path and the exit path of the patients were retrospectively analyzed, using two independent sample t test to compare the statistical index, analyzes the cause of path variation. Results Ranking the first 18 types of variation reasons is patients with complications or complications were 21 cases accounted for 12.2%, due to variation in the number of cases of equipment failure caused by at least 3 cases accounted for 1.7%, negative variance from variation type negative variation, inevitably can avoid all the 78 cases accounted for 44. 8%, positive variance 18 cases accounted for 10. 4% of variation group the average hospitalization days, average hospitalization expenses were higher than the path group, the difference was statistically significant. Conclusions The main factors led to the variation of clinical pathway in the hospital was the unreasonable process of diagnosis and treatment, we could strengthen the clinical pathway management to optimize the diagnosis and treatment process so as to reduce the occurrence of variation.
出处
《中国病案》
2017年第5期42-45,共4页
Chinese Medical Record
基金
新疆医科大学人文社会科学基金项目改革与发展专项基金(2016XYFG40)
关键词
心肌梗死
变异
临床路径
Miocardial infarction
Variation
Clinical pathway
