脑出血实施临床路径的效果评价

目的 探讨脑出血临床路径实施的可行性以及对住院日和医疗费用的控制效果.方法 通过同期队列研究,对实施与未实施临床路径的脑出血患者的住院天数、住院总费用、各种住院费用、患者满意度等指标进行综合比较分析.结果 路径组住院总费用下降[（12520.1±922.5） vs（22757.5±21282.5）元]、药费下降[（6772.6±6388.0） vs（12578.8±10546.1）元]、化验费下降[（1649.3±948.4） vs（2337.1±1745.6）元]与对照组比较差异有统计学意义（p＜0.05）.路径组住院天数缩短[（16.0±6.9）vs（18.1±9.9）天]、检查费下降[（770.7±1064.8） vs（1331.1±2086.2）元]、治疗费下降[（592.5±1108.7）vs（1218.9±2896.1）元],与对照组比较均有下降,但差异无统计学意义（p＞0.05）.路径组患者满意度提高.结论 脑出血临床路径实施后在降低医疗费用和平均住院日、优化诊疗护理工作流程上效果显著.

Clinical pathway in the brain hemorrhage

Objective To investigate the feasibility of clinical pathway implement in patients with cerebral hemorrhage in controlling hospitalization days and medical expense. Methods In this cohort study, patients with supratentorial intracerebral hemorrhage （less than 25 ml） were enrolled from Changhai Hospital from January to December 2013. Patients were divided into clinical pathway group or control group according to the treatment methods they were applied. The hospitalization days, total cost of hospitalization and degree of satisfaction were compared between . the two groups, Results The total cost of hospitalization decreased in clinical pathway group compared with the control group [（12520.1 ±922.5） vs （22757.5 ±21282.5） yuan ].The drug decreased [（6772.6 ±6388） vs （12578.8 ±10546.1） yuan], and testing costs declined [（1649.3 ±948.4） vs （2337.1 ±1745.6） yuan], with significant differences（P 〈 0.05）. The hospitalization days were shorten [（16 ±6.9） vs （18.1 ± 9.9）], examination was down [（770.7 ±1064.8） vs （1331.1 ±2086.2） yuan], and treatment costs were declined [（592.5 ±1108.7） vs （1218.9 ±2896.1） yuan], in the clinical pathway group compared with the control group, but the difference was not statistically significant （P〉0.05）. Implement of clinical pathway also improved the satisfaction of patients. Conclusion The implement of clinical pathway has efficacy in reducing medical cost and the average hospitalization days of cerebral hemorrhage. Optimizing the effect of nursing work process may be the main reason.