三级综合医院外科系统临床路径病种管理效果分析

目的评价三级综合性医院实施临床路径T作后14个病种住院日、术前日和住院费用等效果指标变化情况。方法收集我院外科系统11个院内试点科室的14个试点病种的路径病例492例为路径组，选同期14个病种的非路径病例1011例为对照组，通过住院时间、术前住院时间、住院费用、药品费用等资料的不同，分析临床路径管理的效果。结果路径病例平均住院总时间缩短2．1d，平均总术前住院时间缩短1．2d，其中，腹股沟疝、前列腺增生、子宫肌瘤（经腹全子宫切除术）、声带息肉、慢性硬膜下血肿、乳腺癌、椎间盘突出（胶原酶化学溶解）7个病种的路径组与对照组平均住院时间和术前住院时间差异有统计学意义（P〈0．05）；腰椎间盘突出（开放性手术）住院时间差异有统计学意义（P〈0．05）；实施临床路径后，前列腺增生、慢性硬膜下血肿和椎间盘突出（胶原酶化学溶解）3个病种平均住院费用有所下降，差异有统计学意义（P〈0．05）；但腰椎间盘突出（开放性手术）、颈椎病和老年白内障平均住院费用有所上升。结论临床路径管理缩短住院时间和术前住院时间效果明显，但依病种不同而有差异，也与院科级管理水平及信息化程度有关。

Management of clinical pathways on surgical diseases in third-class comprehensive hospital

Objective To evaluate the management effects of clincal pathway on 14 surgical diseases regarding the length of stay, length of pre-operation and cost of hospitalization. Methods Four hundred and ninety- two patients treated with the clinical pathway （the pathway group） and 1011 patients receiving the routine treatment （the control group） on 14 surgical diseases were selected. The indexes included the cost of hospitalization and the hospitalization time. Results The overall implementation effect is obvious; tthe average hospitalization days and preoperative days were significantly reduced by 2.1 days and 1.6 days. There were statistical differences （ P 〈 0.05 ） in seven diseases （inculding inguinal hernia, prostatic hyperplasia, hysteromyoma, vocal cord polyp, chronic subdural hematoma, breast cancer, lumbar disc herniation （Collagenase chemical dissolution ） between clinical pathway group and non- clinical pathway group in the length of stay and lenth of pre-operation. The length of stay in lumbar disc herniation（ open-operation）, cost of hospitalization of prostatic hyperplasia, chronic subdural hematoma and lumbar disc herniation（ Collagenase chemical dissolution） also showed statistical difference（ P 〈 0.05 ）between two groups. The cost of hospitalization of lumbar disc herniation（ open-operation）, cervical spondylosis and senile cataract slightly increased after the implementation of cliucal pathway. Conclusions The clinical pathway takes effect in surgical diseases to shorten the lengthes of stay and length of pre-operation, but it relies on difference diseases, and is also related to the level of hospital management and construction of information technology.