某三甲医院骨科两病种临床路径的实施效果评价

目的分析重度膝关节骨关节炎和股骨颈骨折两病种实施临床路径的效果，研究临床路径实施中存在的问题并提出改进措施。方法采用t检验对研究组与对照组病例在平均住院日、住院次均费用和住院次均药费三个方面比较分析；采用x2检验（chisquaretest）比较临床科室在实际诊治患者过程中医嘱发生情况与编定的临床路径标准相符程度。结果股骨颈骨折在实施临床路径后平均住院日、住院次均药费差异有统计学意义；术前、术中和术后三类医嘱医嘱符合率不同。结论临床路径的制定和实施是一个系统工程，医院围绕着临床路径的制定和实施过程需要在管理模式、经营理念和运行机制等方面进行改革。

Effect evaluation of the clinical pathway of two orthopedic diseases in a tertiary hospital

objective To analyze the effect of implementation of clinical pathways in two diseases： severe osteoarthritis of the knee and femoral neck fracture, find the existing problems in clinical pathway implementation and make suggestions for improvements. Methods T test was used in the comparative analysis of the average length of stay, hospitalization costs and hospitalization drugs fee of the study group and control group cases; x2 test （chi square test） was used to compare the conformity of actually occurred doctor＇ s order and the clinical pathway standard. Results The difference of average length of stay, drugs fee per stay of femoral neck fracture with or without the implementation of clinical pathways was statistically significant; conformity rate of preoperative, intraoperative and postoperative medical orders was different. Formulation and implementation of clinical pathway is a systematic project, the hospital need to reform its management model, philosophy and mechanism in light of the formulation and implementation of clinical pathway.