临床路径实施前后医疗费用对比分析

目的 对比分析临床路径实施前后各项医疗费用变化情况,评价临床路径的实施效果,为实施单病种付费提供研究基础.方法 采用病历回顾调查的方法,抽取我院临床路径实施前后大肠息肉、结节性甲状腺肿、腰椎间盘突出症住院病人的住院病历,采用t检验、秩和检验等统计方法对比分析其各项住院费用.结果 Wilcoxon秩和检验显示大肠息肉及腰椎间盘突出症住院病人临床路径实施前后的住院天数有统计学差异;大肠息肉临床路径实施前后人均住院总费用分别为5 758.60元、5 118.68元,差异具有统计学意义,临床路径实施后床位费、检查费、药费也显著低于实施前;结节性甲状腺肿临床路径实施后人均住院总费用10 509.91元,低于实施前的11 284.93元,差异具有统计学意义,检查费、药费及护理费在临床路径实施前后同样具有显著性差异,实施后费用显著低于实施前;腰椎间盘突出症临床路径实施前后人均住院总费用差异同样具有统计学意义,实施后为6 860.99元,较实施前有显著降低,临床路径实施后床位费、药费、手术费及其他费用低于实施前,差异具有统计学意义.结论 临床路径的实施有助于减少无效、低效住院日,控制住院天数,降低住院费用.

Comparative analysis of hospitalization costs before and after the clinical pathway implementation

Objective To analyze comparatively the changes of hospitalization costs before and after the clinical pathway implementation, to evaluate its effects and to provide research foundation for single disease payment. Methods Using medical record review survey, samples of colorectal polyps, nodular goiter, lumbar disc herniation inpatients were taken before and after the clinical pathway implementation, and with the use of statistical methods such as t-test and rank sum test, the hospitalization expenses were analyzed comparatively. Results Wilcoxon rank sum test displayed the length of hospitalization days in colorectal polyps and lumbar disc herniation patients before and after the clinical pathway implementation had a statistical difference. The total hospitalization expenses Per capita of colorectal polyps patients before and after the clinical pathway implementation were 5 758.60 and 5 118.68 yuan, and the difference was statistically significant. Bed fee, inspection fee, and drug fee after the clin- ical pathway implementation were significantly lower than those before it. Total hospitalization cost Per capita of nodules goiter in- patients before clinical pathway implementation was 10 509.91 yuan, lower than that before it, and the difference had statistics significance. Inspection fee, drug fee and nursing fee also had a significant difference before and after the clinical pathway imple- mentation. Total hospitalization cost per capita of lumbar disc herniation inpatients before and after the clinical pathway imple- mentation also had a statistical significance, with the cost after the implementation 6 860.99 yuan, significantly reduced than that before it. The bed fee, drug fee, operation fee and other costs after the implementation were less than those before it, and the difference had statistical significance. Conclusion The implementation of clinical pathway contributes to reducing ineffective and inefficient hospitalization days, controlling the length of hospitalization days, and reducing the hospitalization costs.