摘要
目的探讨急性脑梗死(ACI)患者临床路径管理的优化方案及效果。方法回顾性搜集2016年1月—2017年12月神经内科ACI出院患者,根据医院实施循环质量管理(PDCA)前后的不同时间段,在纳入临床路径管理的患者中,分阶段随机抽取ACI病例,对照组选取PDCA循环实施前(2016年1月—12月)纳入临床路径管理的166例患者;研究组选取PDCA循环实施后(2017年6月—12月)纳入临床路径的167例患者。利用SPSS 26.0软件分析数据,对满足正态分布的定量资料进行t检验;对住院费用、住院天数等非正态分布数据采用(M,P_(25)~P_(75))进行描述,采用非参数检验进行统计分析;率之间的比较采用χ^(2)检验。比较两组患者平均住院日、平均住院总费用和费用结构及患者的疾病转归等指标。结果研究组平均住院费用降低至10452.31元,对照组平均住院费用12531.89元,差异具有统计学意义(Z=-4.713,P<0.05),综合医疗服务类费用和治疗类费用升高(Z=-8.671,-2.918,P值均<0.05),药费降低(Z=-7.253,P<0.05),费用结构更加趋于合理。结论PDCA优化临床路径流程,可规范诊疗行为、优化费用结构,有效控制医疗费用增长。
Objective To explore the optimal plan and effect of clinical pathway management for patients with acute cerebral infarction(ACI).Methods ACI patients discharged from Neurology Department from January 2016 to December 2017 were collected.ACI cases were randomly selected in stages among patients included in the clinical pathway management according to the different times before and after implementing of the PDCA cycle in the hospital.The control group selected 166 patients included in the clinical pathway management one year before the implementation of the PDCA cycle(January to December,2016)were selected in the control group.The study group selected 167 patients included in the clinical pathway after implementing the PDCA cycle(June to December,2017).Data were analyzed using SPSS 26.0 software,and t-tests were performed for quantitative data meeting a normal distribution.Non-normal distribution data such as hospitalization costs and hospitalization days were described using(M,P_(25)-P_(75)),and statistical analysis was performed by non-parametric test.The χ^(2) test for counting data was used for the comparison between rates.The mean hospitalization days,mean total hospitalization cost and the cost structure,and disease regression of patients in the two groups were compared.Results The average hospitalization cost decreased to 10452.31 yuan in the study group,and 12531.89 yuan in the control group.The difference was statistically significant(Z=-4.713,P<0.05).The cost of comprehensive medical services and treatment increased(Z=-8.671,-2.918,all P<0.05),drug costs were reduced(Z=-7.253,P<0.05),and the cost structure is reasonable.Conclusion PDCA optimization of the clinical pathway process can regulate the treatment behavior,optimize the cost structure,and effectively control the growth of medical costs.
作者
李玲
崔志刚
杨海
王雅丽
高雪娟
张艳芳
殷巨军
贾佳
LI Ling;CUI Zhigang;YANG Hai;WANG Yali;GAO Xuejuan;ZHANG Yanfang;YIN Jujun;JIA Jia(Department of Medical,the Third People's Hospital of Datong,Datong,Shanxi 037046,China;Department of Neurology,the Third People's Hospital of Datong,Datong,Shanxi 037046,China)
出处
《中国研究型医院》
2022年第1期43-46,共4页
Chinese Research Hospitals
基金
山西省卫生计生委科研课题(2017148)
大同市重点研发计划项目(社会发展)(2020096)。
关键词
医院管理
急性脑梗死
临床路径
Hospital administration
Acute cerebral infarction
Clinical pathway
