脑卒中临床路径试点现状与效果评价

目的评价国家卫生和计划生育委员会临床路径试点工作中，脑卒中临床路径试点的开展情况，分析脑卒中临床路径的实施效果。方法以国家卫生和计划生育委员会临床路径神经内科各试点医院2011年3—10月短暂性脑缺血发作（TIM和脑出血的住院患者确定为传统组：以各试点医院2012年3～10月符合进入该病种临床路径并顺利完成临床路径的住院患者为临床路径组，对两组各项指标的数据进行评估分析。结果TIA实施临床路径后，患者的平均住院天数由（13．19±4．73）d减少到（9．93±4．31）d，（P〈0．01）；平均住院费用由（10584．52±5161．06）元下降到（9200．25±4624．45）元（P〈0．05）；药费由（4479．00±2210．49）元下降到（3843．13±2280．40）元（P〈0．05）；传统组与临床路径组患者90d内卒中发生率分别为12．44％、17．33％（P〈0．16）。脑出血患者实施临床路径后，患者的平均住院天数由（21．18±6．50）d减少到（17．934．6．35）d，（P〈0．01）；平均住院费用由（13514．384．4238．46）元下降到（11737．914．6509．84）元，（P〈O．01）；药费由（7893．054．2356．80）元下降到（6509．84±2044．65）元（P〈0．01）；入院时的神经功能缺损评分（NIHSS）分别为（7．99±3．66）、（7．78±3．67）分（P=0．52）。治疗14d后的NIHSS评分分别为（5．12±3．12）、（4．40±2．74）分（P=0．10）；人院时的Barthel指数（BI）通过秩和检验比较，两者差异无统计学意义（P=0．60），两组患者90d后的BI亦差异无统计学意义（P=0．12）。结论临床路径可以降低TIA及脑出血患者的住院费用及药费；在缩短患者住院天数的情况下，未降低患者医疗质量，甚至在某些医院提高了患者的医疗质量。

The pilot status and effect assessment of stroke clinical pathway

Objective To evaluate the conduct situation of National Health and Family Planning Commission clinical pathways trial implementation of stroke,and analysis the effect of clinical pathway of cerebral apoplexy. Methods The transient isehemic attack （TIA） and cerebral hemorrhage patients in hospitalized with national health and family planning commission clinical pathway in the neurology experimental hospital from March to October 2011 patients identified as traditional group;The hospitalized patients in the pilot hospitals from March to October 2012who meet the disease types of clinical pathway and the smooth completion of clinical pathway for the clinical pathway group,the indicators data on two groups was evaluated and analyzed respectively. Results The TIA patients after the implementation of clinical pathway,the average hospitalization clays for patients from （13.19±4.73） days reduced to （9.93±4.31） clays （P〈0.01）;The average hospitalization costs from （10 584.52±5161.06） yuan reduced to （9200.25±4624.45） yuan（P〈0.05）; The charges for medicine from （4479.00±2210.49） yuan reduced to （3843.13±2280.40） yuan （P〈0.05）;Patients with stroke incidence within 90 days was 12.44% and 17.33% in traditional group and clinical pathway group respectively （P=0.16）.The cerebral hemorrhage patients after the implementation of clinical pathway,the average hospitalization days for patients from （21.18±6.50） days reduced to （17.93±6.35） days （P〈0.01）;The average hospitalization costs from （13 514.38±4238.46） yuan reduced to （11 737.91±6509.84） yuan（P〈0.05）;The charges for medicine from （7893.05± 2356.80） yuan reduced to （6509.84±2044.65） yuan （P〈0.05）;The nerve function defect score （NIHSS） on admission to hospital was （7.99±3.66） scores and （7.78±3.67） scores respectively （P=0.52）.The NIHSS after 14 d treatment was （5.12±3.12） scores, （4.40±2.74） scores respectively （P=0.10）.Barthel index （BI） on admission to hospital by compared rank and inspection,there was no statistically significant difference between the two groups （P=0.60）,the BI after 90 d between the two groups of patients also had no statistically significant difference （P=-0.12）. Conclusion Clinical pathway can reduce the hospital costs and the expenses of medicine in TIA and cerebral hemorrhage patients.Clinical pathway in shorten TIA and cerebral hemorrhage,in-hospital days of cases,patients with no reduction in quality of medical treatment,even in some hospitals it can improve the patient＇s medical quality.