临床路径在高龄双膝关节表面一期置换中的应用研究

目的研究临床路径对高龄双膝关节表面一期置换术临床效果的影响。方法选取我院不同时期双膝关节表面一期置换患者46例,对照组21例采用常规护理,试验组25例采用临床路径进行治疗和护理。对两组术后并发症发生率,平均住院天数,住院费用,1、2周膝关节功能评分进行比较。结果术后围手术期并发症发生率、平均住院天数及住院费用试验组低于对照组（P均〈0．05）;术后1、2周膝关节功能评分试验组高于对照组（P均〈0．05）。结论应用临床路径能够减少高龄双膝关节表面一期置换住院患者围手术期并发症发生率、住院天数和住院费用,短期内提高患者的功能恢复和生活质量。     

慢性稳定型心绞痛中西医结合临床路径实施效果评价

目的评估慢性稳定型心绞痛中西医结合临床路径实施效果。方法采用非同期历史对照研究实施临床路径规范化管理后,评估其对患者安全性、住院费用、住院天数及临床疗效的影响。结果与传统组比较,路径组患者住院费用及住院天数均有明显下降(P0.05),心绞痛疗效、心电图疗效、中医证候疗效明显提高(P0.05)。结论对于慢性稳定型心绞痛患者实施中西医结合临床路径,可在保证临床疗效的同时降低住院费用及住院天数。     

临床护理路径在支气管哮喘患者中的应用研究

目的探讨临床护理路径在支气管哮喘患者中的应用。方法将102例支气管哮喘住院患者随机分为对照组和临床护理路径组,各51例,对照组给予常规护理,临床护理路径组按临床护理路径护理,对两组患者平均住院天数、住院费用、护理工作满意度、健康教育达标率、半年内随访复发例数进行比较。结果临床护理路径组患者平均住院天数、住院费用、半年内随访复发例数均显著低于对照组,差异有统计学意义(P<0.05);健康教育达标率与护理工作满意度明显高于对照组,差异有统计学意义(P<0.05)。结论实施临床护理路径明显降低了支气管哮喘患者住院天数、住院费用、哮喘复发率,提高了患者满意度,值得在临床推广应用。     

临床护理路径在心肌梗死患者中的应用

目的建立完善的急性心肌梗死患者的临床护理路经。方法选取我科54例急性心肌梗死患者作为对象,临床路径组（观察组）和对照组各27例,用临床路径的标准方案与传统临床护理方案作比较。结果观察组患者住院天数、卧床时间、住院费用、并发症的发生率比对照组明显减少。结论临床护理路径在急性心肌梗死患者中的应用,可提高工作效率和患者的满意度,控制成本和保证护理质量。     

临床护理路径在病毒性肝炎肝硬化合并消化道出血患者中的应用效果分析

目的探讨在乙型病毒性肝炎肝硬化合并消化道出血患者中实施临床护理路径的效果。方法选择196例乙型病毒性肝炎肝硬化合并消化道出血患者为研究对象,随机分为对照组和观察组,每组98例。对照组患者给予常规护理及健康指导,观察组患者按照临床护理路径对患者进行护理及健康教育,观察分析两组患者的住院天数、生活质量评分、对护理服务的满意度及健康教育达标情况。结果观察组患者住院天数显著少于对照组,差异有统计学意义(P0.05);观察组患者生活质量评分、对护理服务的满意度及健康教育达标率均优于对照组,差异有统计学意义(P0.05)。结论临床护理路径在病毒性肝炎肝硬化合并消化道出血患者中的应用,可缩短患者的住院时间、提高患者生活质量,提高患者对护理服务的满意度及健康教育达标率。     

临床护理路径在尘肺患者健康教育中的应用

目的探讨临床护理路径在尘肺患者健康教育中的应用效果。方法将60例尘肺住院患者按住院顺序随机分为观察组和对照组各30例,分别用临床护理路径模式和常规模式开展健康教育,于出院日比较两组健康教育效果及平均住院天数、住院费用和护理满意度。结果两组健康教育效果比较,观察组在尘肺病基本知识、心理调节能力、呼吸功能锻炼、自我管理能力等方面的达标率均明显高于对照组,差异有统计学意义(P0.05);观察组平均住院天数、住院费用低于对照组,护理满意度高于对照组,差异有统计学意义(P0.05)。结论临床护理路径应用于尘肺患者健康教育,可提高健康教育效果,缩短住院时间,降低住院费用,提高患者对护理的满意度,值得临床应用。     

临床护理路径在晚期血吸虫病巨脾型患者标准化管理中的应用

目的 目的 研究晚期血吸虫病巨脾型患者临床护理路径标准化管理的可行性及实施效果。方法 方法 将64例晚期血吸虫病巨脾型患者随机分为常规护理组 （对照组） 和临床护理路径组 （CNP组）, 分析比较2组患者术后情况、 平均住院日、 住院费用及满意率的区别。结果 结果 实施临床护理路径后, 晚期血吸虫病巨脾型患者的术后并发症、 平均住院日、 住院费用较对照组明显减少, 患者满意度从81.25%上升至100%。结论 结论 在晚期血吸虫病巨脾型患者治疗中实施CNP标准化管理有效降低了患者住院天数、 费用和并发症的发生, 提高了患者满意率。     

临床路径对大面积脑梗死神经功能康复及费用控制影响

目的探讨临床路径对大面积脑梗死患者神经功能康复及费用控制的作用。方法将61例大面积脑梗死患者随机分为两组,观察组31例采用制订好的临床路径进行治疗,对照组30例采用传统的治疗方法。观察两组患者的NIHSS评分、Barthel指数、并发症发生率、病死率、住院天数、医疗费用及病人满意度。结果与对照组比较,观察组患者NIHSS评分有明显下降,Barthel指数有显著提高,并发症的发生率显著减少,住院天数明显缩短,医疗费用显著减少,差异均有统计学意义（ P＜0.05,＜0.01）;病死率虽有降低,满意度虽有提高,但无统计学意义（ P＞0.05）。结论临床路径在大面积脑梗死患者中的应用,能显著改善神经功能缺损,提高医疗质量,具有良好的社会、经济效益,值得进一步推广。     

慢性心力衰竭中西医结合临床路径实施效果评价

目的评价慢性心力衰竭中西医结合临床路径的实施效果。方法采用非同期历史对照研究,评估实施临床路径对病人住院费用、住院天数及临床疗效的影响。结果与常规组比较,路径组住院费用显著下降,住院天数明显缩短,差异有统计学意义(P0.05),中医证候疗效、部分中医单项症状疗效(胸闷、气短、下肢浮肿、汗出)、心功能疗效优于常规组(P0.05)。结论慢性心力衰竭病人住院期间实施中西医结合临床路径可降低住院费用及减少住院天数,改善临床症状、中医证候,提高心功能。     

支气管镜肺泡灌洗在尘肺并阻塞性肺炎的应用价值

目的观察支气管镜肺泡灌洗在治疗尘肺合并阻塞性肺炎中的临床疗效及安全性。方法将168例尘肺并单纯阻塞性肺炎患者随机分为观察组及对照组各84例,对照组给广谱抗感染联合舒张支气管、祛痰等治疗,观察组在此基础上给予支气管镜肺泡灌洗治疗,治疗后比较临床疗效及抗生素使用天数、住院天数和住院费用。结果观察组有效率96.4%,对照组有效率69.1%,两组比较差异有统计学意义,P0.05;观察组平均抗生素使用天数、住院天数及住院费用均明显短于对照组,P均0.05。观察组未见严重并发症。结论经支气管镜肺泡灌洗治疗尘肺合并阻塞性肺炎能早期改善患者临床症状,提高疗效,缩短患者抗生素使用疗程,减少患者住院天数及住院费用,且安全,值得临床推广应用。     

An economic evaluation on the clinical pathway for gastrectomy]

OBJECTIVE: To analyze the costs of gastrectomy patients treated with the clinical pathway. PATIENTS AND METHODS: Seventy-six patients (path group 44, control 32) had undergone gastrectomy in our hospital in 2001. The clinical pathway included the same care map. Treatment costs were estimated from medical cost receipt data. The economical analysis was performed from the point of the direct cost payer's view. RESULTS: The length of hospital stay in the path group was 27.1 +/- 5.9 days and decreased 8.3 days in comparison with the control(p < 0.001). The cost of the path group was 145.290 +/- 23.773 points and 19.278 points less than the control(p < 0.005). In the path group the operation case per bed was increased 30% and the cost per bed was also increased 15% more than the control. CONCLUSIONS: The implementation of the clinical pathway decreased the length and the cost of hospital stay. The clinical pathway is effective to use the hospital resources, such as bed.     

Standardized-care pathway vs. usual management of syncope patients presenting as emergencies at general hospitals.

AIMS: The study hypothesis was that a decision-making approach improves diagnostic yield and reduces resource consumption for patients with syncope who present as emergencies at general hospitals. METHODS AND RESULTS: This was a prospective, controlled, multi-centre study. Patients referred from 5 November to 7 December 2001 were managed according to usual practice, whereas those referred from 4 October to 5 November 2004 were managed according to a standardized-care pathway in strict adherence to the recommendations of the guidelines of the European Society of Cardiology. In order to maximize its application, a decision-making guideline-based software was used and trained core medical personnel were designated-both locally in each hospital and centrally-to verify adherence to the diagnostic pathway and give advice on its correct application. The 'usual-care' group comprised 929 patients and the 'standardized-care' group 745 patients. The baseline characteristics of the two study populations were similar. At the end of the evaluation, the standardized-care group was seen to have a lower hospitalization rate (39 vs. 47%, P=0.001), shorter in-hospital stay (7.2+/-5.7 vs. 8.1+/-5.9 days, P=0.04), and fewer tests performed per patient (median 2.6 vs. 3.4, P=0.001) than the usual-care group. More standardized-care patients had a diagnosis of neurally mediated (65 vs. 46%, P=0.001) and orthostatic syncope (10 vs. 6%, P=0.002), whereas fewer had a diagnosis of pseudo-syncope (6 vs. 13%, P=0.001) or unexplained syncope (5 vs. 20%, P=0.001). The mean cost per patient and the mean cost per diagnosis were 19 and 29% lower in the standardized-care group (P=0.001). CONCLUSION: A standardized-care pathway significantly improved diagnostic yield and reduced hospital admissions, resource consumption, and overall costs.     

Clinical pathway for inpatients with gastric ulcer: evaluation of usefulness]

Based on the results of a retrospective review of clinical data on inpatients with gastric ulcer treated at our department, we devised on original clinical pathway and tested it in the clinical setting. From the results obtained, we created an improved clinical pathway and evaluated its usefulness. The duration of hospitalization was 16.2 +/- 6.9 (mean +/- SD) days in the non-path group, 14.1 +/- 3.0 days in the original path group, and 10.9 +/- 2.0 days in the improved path group. The hospital time was significantly shorter in the improved path group. For patients with bleeding gastric ulcer, the duration of hospitalization was 18.0 +/- 6.3 days in the non-path group, 15.1 +/- 2.3 days in the original path group, and 11.2 +/- 1.8 days in the improved path group. This period was also significantly shorter in the improved path group. With regard to the occurrence of rebleeding from the gastric ulcers, there were no significant differences between the non-path group and both clinical path groups. These results indicate that devising a clinical pathway is useful for shortening the duration of hospitalization for patients with gastric ulcer.     

Case management may reduce length of hospital stay in patients with recurrent admissions for chronic obstructive pulmonary disease

OBJECTIVES: The aim of the study was to determine whether the case management of patients with recurrent hospital admissions for chronic obstructive pulmonary disease (COPD) can reduce hospital days without reducing quality of life. METHODOLOGY: Sixteen subjects (mean forced expiratory volume in 1 second; FEV1 0.64 L) with at least four admissions for COPD in the previous 2 years were case managed by a clinical nurse specialist. Admissions and hospital bed days were recorded before and after the introduction of case management, and compared with data for 16 controls at another hospital who received usual care. Quality of life was measured serially in the case-managed group. RESULTS: In the first year of case management, the number of hospital bed days fell to eight per patient from 22 per patient in the previous year. This was mainly due to a reduction in the length of stay from 5.6 to 3.5 days. In the control group length of stay did not change. Admissions in both groups declined. Case-managed patients had a significant improvement in their quality-of-life scores. CONCLUSIONS: In a group of patients with severe COPD and recurrent admissions, case management reduced the number of days in hospital while improving the quality of life. These findings need to be confirmed in a randomized, controlled trial.     

静滴大剂量丙种球蛋白治疗重症病毒性脑炎35例临床观察

目的探讨静脉滴注丙种球蛋白（IVIG）治疗病毒性脑炎的临床疗效。方法将72例病毒性脑炎患者分为治疗组35例和对照组37例,对照组行常规治疗,治疗组在常规治疗基础上,静脉滴注IVIG400mg·kg-1.d-1,连续5d。比较两组症状、体征消失时间及住院天数。结果治疗组临床症状、体征消失时间及住院时间均短于对照组（P〈0.05）。结论 IVIG对于改善病毒性脑炎主要的症状和体征效好果,并能缩短住院天数。     

Alcohol consumption and community hospital admissions in the United States: a dynamic regression analysis, 1950–1992

The annual time-series analysis examines the impact of changes in per capita alcohol consumption (NIAAA, AIDS) an changes in community hospital admission rates (AHA) in the United States from 1950 to 1992 (n = 43). Increases in per capita alcohol consumption were expected to increase hospital admission rates contemporaneously and several years thereafter following an exponential risk function. Distributed lag models based on differenced data controlling for changes in: (I) per capita cigarette consumption; (2) private hospital insurance coverage; (3) the drinking age population; (4) per capita disposable personal income; and (5) health care regulatory interventions show a contemporaneous effect of per capita alcohol consumption on hospital admission rates. The time-series analyses imply that between 22–26% of US community hospital admissions are alcohol related. A comparable analysis indicates that per capita alcohol and tobacco expenditures contribute to approximately 28% of US community hospital admissions. The absence of statistically significant lagged effects is inconsistent with an exponentially declining risk function. However, the contemporaneous effects of per capita alcohol and tobacco consumption suggest that a reduction in smoking and drinking will produce quick reductions in morbidity and hospitalizations.     

抗菌药物预防性应用在重型病毒性肝炎治疗中的价值

目的:调查抗菌药物预防性应用对重型病毒性肝炎医院感染的影响,并探讨其应用机制。方法:选择入院前1周未经抗菌治疗、入院时无感染征象、住院时间超过72小时的重型肝炎病例,根据临床分期及抗菌药物应用情况分组、对照研究。结果:159例患者中76例发生医院感染,未预防性应用抗菌药物组(A组)、静脉注射第三代头孢菌素组(B组)及半合成青霉素组(C组)医院感染率分别为56.16％(41/73)、34.01％(17/50)和50.0％(18/36),B组明显低于A组(P<0.05);B组医院感染发生时间较A组明显推迟,B组可降低中期重型肝炎的病死率、与A组比较有显著性差异(16.67％ us 50.0％,P<0.05)。结论:早期患者应用预防性抗菌药物可推迟医院感染发生时间,但对降低医院感染率及病死率无统计学意义;中、晚期患者预防性应用第三代头孢菌素对推迟医院感染发生时间、降低医院感染率及病死率是有效的。     

The effect of a multidisciplinary program on HAART adherence

Although emerging evidence suggests differing interventions may improve antiretroviral adherence, there has not been a formal evaluation to identify the impact of a clinic-based multidisciplinary program designed to provide education and identify and correct potential adherence barriers prior to the initiation of highly active antiretroviral therapy (HAART). A retrospective cohort study utilizing a historical control group was conducted to compare duration on antiretrovirals, clinical indicators, and adherence rates, as captured by pharmacy refill records. Two hundred sixty-one patients met criteria for inclusion (109 subjects, 152 controls). Time to stopping antiretrovirals, as evidenced by Kaplan-Meier plot, was significantly higher in Protocol group than Controls (log-rank p = 0.023): the median duration on HAART for the intervention group was greater than 360 days but only 210 days for the control group. Thus, more subjects in the protocol group continued on therapy for the full year: 60 (55%) versus 65 (43%) for the control group. The mean reduction in log10 viral loads between HAART initiation and 12 months was greatest for the intervention group with viral load at HAART initiation 100,000 copies per milliliter or more, -3.57 versus -1.78 for controls with viral load less than 100,000 copies per milliliter (p < 0.001). For the intervention group, the mean number of adherence barriers identified per person was 4% and 72% were found to have three or more barriers. Patients at high risk for poor adherence benefit from multidisciplinary education and proactive identification of adherence barriers by exhibiting prolonged duration on therapy and greater reduction in log10 viral loads.     

A randomized trial of comprehensive geriatric assessment and home intervention in the care of hospitalized patients

OBJECTIVE: to prove the effectiveness of geriatric evaluation and management for elderly, hospitalized patients, combined with post-discharge home intervention by an interdisciplinary team. DESIGN: randomized controlled trial with outcome and costs assessed for 12 months after the date of admission. SETTING: university-affiliated geriatric hospital and the homes of elderly patients. SUBJECTS: 545 patients with acute illnesses admitted from home to the geriatric hospital. INTERVENTIONS: patients were randomly assigned to receive either comprehensive geriatric assessment and post-discharge home intervention (intervention), comprehensive geriatric assessment alone (assessment) or usual care. MAIN OUTCOME MEASURES: survival, functional status, rehospitalization, nursing home placement and direct costs over 12 months. RESULTS: the intervention group showed a significant reduction in length of hospital stay (33.49 days vs 40.7 days in the assessment group and 42.7 days in the control group; P < 0.05) and rate of immediate nursing home placement (4.4% vs 7.3% and 8.1%; P < 0.05). There was no difference in survival, acute care hospital readmissions or new admissions to nursing homes but the intervention group had significantly shorter hospital readmissions (22.2 days vs 34.2 days and 35.7 days; P < 0.05) and nursing home placements (114.7 days vs 161.6 days and 170.0 days; P < 0.05). Direct costs were lower in the intervention group [about DM 7000 (US $4000) per person per year]. Functional capacities were significantly better in the intervention group. CONCLUSIONS: comprehensive geriatric assessment in combination with post-discharge home intervention does not improve survival, but does improve functional status and can reduce the length of the initial hospital stay and of subsequent readmissions. It can reduce the rate of immediate nursing home admissions and delay permanent nursing home placement. It may also substantially reduce direct costs of hospitalized patients.     

Usefulness of clinical pathway for community-acquired pneumonia as both an educational and a cost-management tool--an intervention study to compare the usefulness of management with a critical pathway to historical control of conventional management]

To delineate the usefulness of a clinical pathway for community-acquired pneumonia (CAP) as an educational tool as well as a cost management tool, we conducted a prospective controlled trial including a historical control group. Consecutive CAP patients classified under Category 3 of the American Thoracic Society and admitted to our hospital were evaluated. Using the clinical pathway method, 42 patients were managed between April and December 2000 as the intervention group, and 33 patients received conventional management between April and December 1999 as a historical control. For the intervention group, the clinical pathway, which was a time-task matrix formatted with consideration for guidance for disease treatment, laboratory tests, physical examinations, oxygen saturation monitoring, ambulation, diet, education for the patient and clinical outcomes, was implemented. We determined (1) educational effect, measured using reduction of delay caused by physicians; (2) quality of clinical practice, measured using the success rate of the initial antimicrobial therapy and readmission rate; and (3) economic efficacy, measured using health care cost and length of hospital stay. The delay caused by physicians was reduced by 16% in the Intervention Group (5% vs. 21%; p = 0.045). The success rates of initial antimicrobial therapy in the two groups were similar (85.7% vs. 84.8%). In the intention-to-treat set, the median value of health care cost was reduced by yen 48,055 (yen 277,460 vs. yen 325,515; p = 0.017) and the median length of a hospital stay was shortened by 3 days (8 vs. 11 days; p = 0.0007) in the Intervention Group. In conclusion, the clinical pathway had an educational effect on physicians regarding the management of hospitalized patients with community-acquired pneumonia as well as on the cost management.