论文部分内容阅读
目的:进一步明确基层医疗机构实施临床路径管理的效果和实际意义。方法:对江西省基层医疗机构实施的24种常见病、多发病的临床路径试点情况进行数据采集,录入Excel(2007)进行逻辑检验,并对符合逻辑的数据进行统计学的频数分析和相关分析。结果:全省226家基层医疗卫生机构累计完成入径病例8 428例,完成路径病例7 856例,让24个试点病种患者得到了全程精细化管理治疗,住院天数降低显著,治疗费用下降明显,治愈率和满意度提高。实施临床路径后住院病人的住院天数下降均超过10%。下降率>30%的共有11种病,占此次施行24个病种的45.83%;下降率20%～30%,有9种病,占37.5%;下降率20%～10%的有4个病种。治疗费用下降率大于40%的病种有5个,治疗费用下降了20%～40%的病种有5个,占24种病种的20.83%;治疗费用下降了10%～20%的病种有12种,占50%。医疗机构问卷调查显示在进行诊疗路径管理的机构,诊疗行为更加规范、合理的机构占95.48%;医疗纠纷减少的医疗机构占77.40%;治愈率上升的医疗机构占79.10%;患者满意度提高的医疗机构占84.75%。结论:基层医疗机构实施临床路径管理,医疗供需双方都得到实惠。对规范医疗行为、科学合理确定看病费用、促进双向转诊机制构建、新农合医疗费用支付方式的改革、医务人员医疗水平提升等提供了丰富的实证参考。建议在全国基层开展临床路径试点工作,不断总结和推广,解决广大群众看病难和看病贵。
Objective: To further clarify the effect and practical significance of the implementation of clinical path management in primary medical institutions. Methods: The clinical data of 24 common and frequently-occurring clinical pathways implemented by primary medical institutions in Jiangxi Province were collected and recorded in Excel (2007) for logistic test. Statistical analysis of frequency and correlation . Results: A total of 8 428 cases of pathological changes were completed in 226 primary health care institutions in the province, of which 7 856 cases were completed. Twenty-four pilot cases were managed intensively throughout the course of treatment. The days of hospitalization decreased significantly and the cost of treatment decreased significantly , The cure rate and satisfaction increased. Inpatient hospitalization days after implementation of the clinical pathway decreased by more than 10%. The rate of decline was> 30% of the total of 11 kinds of diseases, accounting for 45.83% of the 24 kinds of the implementation of the disease; the rate of decline of 20% to 30%, 9 kinds of diseases, accounting for 37.5%; the rate of decline of 20% to 10% A disease. There were 5 kinds of diseases whose treatment cost was reduced more than 40%, 5 kinds of diseases whose treatment cost was reduced by 20% ~ 40%, accounting for 20.83% of 24 kinds of diseases; the treatment cost was reduced by 10% ~ 20% There are 12 species, accounting for 50%. The questionnaire survey of medical institutions shows that 95.48% of the institutions with more standardized and reasonable diagnosis and treatment behaviors are responsible for the management of pathways, 77.40% of the medical institutions with less medical disputes, 79.10% of the medical institutions with the higher cure rate, Medical institutions accounted for 84.75%. Conclusion: The implementation of clinical path management in primary medical institutions has benefited both medical supply and demand. It provides a wealth of empirical references for standardizing medical behaviors, scientifically and reasonably determining the cost of seeing a doctor, promoting the establishment of a two-way referral mechanism, reforming the payment modalities for medical expenses of NCMS, and improving the medical care of medical personnel. It is suggested that pilot work should be carried out at the grassroots level across the country to continuously review and popularize the disease so that it will be difficult for the general public to see a doctor and seek medical attention.