基于价值医疗的胸外科加速康复外科实践效果研究

目的以提升医疗价值为前提,通过探索加速康复外科系列实践措施,优化围术期临床路径,最终在保障安全的前提下,改善医疗服务效率和服务质量,降低医疗成本。方法基于《加速康复外科中国专家共识》及《欧洲胸外科快速康复指南》,打破专业壁垒,建立以患者为中心的肺部肿瘤术前、术中、术后加速康复外科路径(涵盖麻醉、外科、护理多学科优化措施),并围绕价值医疗评价体系指标对加速康复外科实施前后运用效果进行分析。结果在保障围术期并发症及再入院率无显著增加的前提下,加速康复外科平均缩短术后住院日1.63天(P<0.001),患者次均医疗成本降低13.2%(P<0.001),术后48小时出院率达87.2%。结论基于多学科整合医疗模式有利于加速康复外科的顺利开展,是改善医疗服务、实现价值医疗的有效手段。

Research of the Effectiveness of Thoracic Surgery Enhanced Recovery Practice in the Improvement of Medical Value

Objective Based on the premise of medical value,to optimize clinical pathway during perioperative period through exploring the practical measures of enhanced recovery surgery,to improve medical service efficiency and service quality,and to reduce medical cost on the premise of safety guarantee ultimately.Methods Based on China Enhanced Recovery Surgery Expert Specialist ERAS and Europe Thoracic Surgery Enhanced Recovery Guidance,breaking major barrier;establishing enhanced recovery surgery pathway before,during and after lung tumor operation through taking patients as the center,including the muti-discipline optimization measures in anesthesia,surgery and nursing;analyzing the application effect before and after enhanced recovery surgery implement according to value healthcare evaluation system indicators.Results Under the circumstances that postoperative complications and rehospitalization were not increased significantly,the mean postoperative hospital stay was shortened by 1.63 days(P<0.001)and the median cost during hospitalization was reduced by 13.2%(P<0.001).There were 87.2%patients could be discharged within 48 hours after lung surgeries.Conclusion Multiple evidence-based ERAS contributed to improving the smooth development of enhanced recovery surgery.It is the effective means of improving medical service and achieving value healthcare.