实行临床路径管理对医生诊疗行为影响的研究

目的 观察临床路径管理干预对医疗服务行为的影响.方法 回顾性分析2011-2013年入住河北省张家口市某三甲医院的病例资料,观察并分析实施临床路径管理对诊断结果、病历书写质量、临床用药、手术、住院时间、医疗费用、辅助检查项目选择的影响.结果 两组患者3个病种入出院诊断符合率、手术前后诊断符合率均为100%,差异无统计学意义(P>0.05).实施临床路径组患者出院病历甲级率明显高于未实施临床路径组,乙级率明显低于未实施临床路径组,差异有统计学意义(P<0.05).实施临床路径组抗菌药物费用、药占比明显低于未实施临床路径组,目录内用药比例明显高于未实施临床路径组,差异有统计学意义(P<0.05).实施临床路径组术前准备时间明显少于未实施临床路径组(P<0.05),而两组切口甲级愈合率无明显差异(P>0.05).实施临床路径组平均住院时间、总费用、药费、化验费、检查费明显低于未实施临床路径组(P<0.05),两组患者手术费、卫生材料费、护理费差异无统计学意义(P>0.05).实施临床路径组实验室、影像及其他检查项目数量少于未实施临床路径组(P<0.05).结论 实施临床路径能够规范医生诊疗行为,使医疗工作向更有利于患者的方向发展.

Study on influence of clinical pathway management on physician diagnosis and treatment behaviors

Objective To observe the influence of the clinical pathway management intervention on medical service behaviors.Methods The clinical cases data in a grade A class 3 hospital of Zhangjiakou City,Hebei Province during 2011-2013 were retrospectively analyzed.The influence of implementing the clinical pathway management on the diagnosis results,medical records writing quality,clinical medication,operation,hospitalization time,medical costs,assisted examination items selection were observed and analyzed.Results The admission and discharge diagnosis coincidence rate and preoperative and postoperative diagnostic coincidence rate of 3 diseases entities in the two groups were 100%,the difference had no statistical significance (P>0.05);the medical record grade-A rate in the implementing clinical pathway group was significantly higher than that in the non-implementing clinical pathway group,the medical record grade-B rate was significantly lower than that in the non-implementing clinical pathway group,the difference was statistically significant (P<0.05);the antibacterial drugs cost and drugs proportion in the implementing clinical pathway group were significantly lower than those in the non-implementing clinical pathway group,the medication proportion within the directory in the implementing clinical pathway group was significantly higher than that in the non-implementing clinical pathway group,the difference was statistically significant (P<0.05);the preoperative preparation time in the implementating clinical pathway group was less than that in the non-implementing clinical pathway group,the difference was statistically significant(P<0.05),the grade-A healing rate had no significant difference between the two groups (P>0.05);the average hospitalization time,total costs,drug costs,laboratory fee and examination fee in the implementing clinical pathway group were lower than those in the non-implementing clinical pathway group,the difference was statistically significant (P<0.05);the operation fee,healthy material fee and nursing fee had no statistically significant difference was statistically significant(P<0.05).Conclusion Implementing the clinical pathway can standardize the doctor′s diagnosis and treatment behaviors and makes the medical work to develop to be more favorable for patients.