消化内科6种疾病临床路径变异原因分析及措施

目的对消化内科6种疾病变异原因进行分析总结,以便推广使用。方法对2010年3月～2011年1月119例临床路径患者变异原因进行总结、归类,通过分析讨论,制定变异控制措施。结果 119例患者中有71例患者出现不同程度的变异,变异率59.7%。有32例出现2次以上变异,其中有17例因变异而终止路径。路径终止变异率14.3%。结论在实施临床路径时,出现变异是不可避免的,有些变异会导致路径终止,而大多数变异不影响路径的完成。疾病本身因素导致变异是难以控制的;而医生及患者等主观因素导致变异是可以控制的。可控变异的主要原因是不合理用药和过度检查,须在以后加强管理。

Causes of Variance and Countermeasures for Clinical Pathways of Six Diseases in Department of Gastroenterology

Objective To analyze the causes of variance in six diseases in Department of Gastroenterology to promote the use of clinical pathway. Method From March 2010 to January 2011, the causes of variance of 119 patients in clinical pathways were summarized and classified. Through analysis and discussion, the control measures were developed. Result Among the 119 pa- tients, 71 patients had different degrees of variation with variation rate of 59.7%. More than two times of variation happened in 32 cases, of which 17 cases terminated pathway due to variation. Path termination variation rate was 14.3%. Conclusion Variation is inevitable during the implementation of clinical pathways. Some variation will cause the termination of path, and most variations do not affect the completion of the path. Variation caused by disease itself is difficult to control ; while, variation caused by sub- jective factors, such as doctors and patients, can be controlled. Controllable variation mainly due to the irrational use of medicine and over - examination, and the management should be strengthened in the future.