广东省某中医院临床路径管理评价的实证研究

发布时间：2018-06-30 09:50

本文选题：临床路径 + 管理　；参考：《广州中医药大学》2017年硕士论文

【摘要】：目的:本文通过梳理和总结临床路径管理评价经验,遴选出一套能够科学、有效的评价中医院临床路径管理的指标,对广东省某三甲中医院进行实证研究,评价中医院的临床路径实施过程和实施效果情况,找出中医院临床路径管理模式中存在的问题并提出对策,从而加强医院医务人员对中医院临床路径工作的注重,进一步促进和提升中医院临床路径管理水平。方法:本研究首先结合课题研究成果,通过查阅大量相关参考文献,初步遴选出一套科学性好、权威性高、适用性强的临床路径管理评价指标体系。第二,通过专家访谈,对课题组专家及广东省中医院项目疗效办负责人等专家,就如何科学有效的评价中医院临床路径实施过程和实施效果进行交流访谈,为遴选合适的、可操作性的中医院临床路径管理评价指标指明方向。第三,对广东省某三甲中医院进行实证研究,调查收集各指标条目统计数据,采用对比分析法,对该医院2015年度、2016年度临床路径管理实施效果进行总体分析,并对2016年度该医院的临床路径管理实施情况进行各临床路径之间对比,分析探寻最优临床路径。结果:确定了评价中医院临床路径管理实施情况的15个指标,对广东省某中医院进行实证研究,结果显示,实证医院2016年度临床路径管理的病种入径率均值为60.39%,比2015年度均值51.20%有明显提高,且经过独立样本T检验,P0.05,差异具有统计学意义;在各临床路径分组中,心血管科的心房颤动临床路径在筛选后的两两比较病种入径率(正向指标)中秩均值最高,消化科的大肠息肉临床路径在各个临床路径的对比分析中次均药品费用(负向指标)的平均秩次最低,且秩和检验P0.05,具有显著性差异,差异具有统计学意义。结论:本研究结果显示,实证医院2016年度临床路径管理整体评价比2015年度优越。临床路径实施过程效率得到提升,其中病种入径率和路径完成率均有所提高,但路径完成率不高,路径变异率较高且有所增长,应加强临床路径实施的前期管理与后期总结,提高临床路径管理执行力。临床路径实施效果取得良好发展,平均住院日持续降低,病死率稳步控制,临床路径疗效更为达标,但再入院率有微幅增长,应进一步规范诊疗过程和提高医疗质量。中医药运用全面加强,中药饮片、中成药和中医特色疗法在临床路径管理中得到广泛使用,但中医药费用占比不高,应在临床路径实施中进一步突出中医药特色优势,提升中医药的社会效益和经济效益。医用耗材控费良好,但平均医疗费用有所上涨,应进一步规范诊疗过程,加强住院费用及药品费用的监控;临床路径信息化建设不完善,仍需要将临床路径与电子病历有效结合,重点做好系统的路径管理环节。此外,2016年实证医院临床路径管理中,心房颤动临床路径的病种入径率最高,大肠息肉临床路径对药品费用控制最好。
[Abstract]:Objective: through combing and summing up the experience of clinical path management evaluation, this paper selected a set of scientific and effective indicators to evaluate the clinical path management of traditional Chinese medicine hospitals, and carried out an empirical study on one of the top three traditional Chinese medicine hospitals in Guangdong Province. To evaluate the process and effect of clinical path implementation in Chinese medicine hospital, to find out the problems existing in the clinical path management mode of traditional Chinese medicine hospital and to put forward countermeasures, so as to strengthen the attention of medical staff to clinical path work in Chinese medicine hospital. To further promote and enhance the level of clinical path management in Chinese medicine hospitals. Methods: based on the research results, a set of scientific, authoritative and applicable evaluation index system of clinical path management was preliminarily selected by consulting a large number of relevant references. Second, through the expert interview, the experts of the research group and the head of the project curative effect office of Guangdong traditional Chinese medicine hospital, etc., exchange interviews on how to scientifically and effectively evaluate the implementation process and effect of the clinical path of the traditional Chinese medicine hospital, so as to select the appropriate one. The operable evaluation index of clinical path management in Chinese medicine hospital indicates the direction. Thirdly, an empirical study was carried out on a top three Chinese medicine hospital in Guangdong province. The statistical data of each index item were collected, and the overall effect of clinical path management in 2015 to 2016 was analyzed by comparative analysis. The implementation of clinical pathway management in this hospital in 2016 was compared and the optimal clinical pathway was analyzed. Results: fifteen indexes to evaluate the implementation of clinical path management in traditional Chinese medicine hospital were determined, and an empirical study was carried out on a Chinese medicine hospital in Guangdong province. The results showed that, The average disease entry rate of clinical path management in the empirical hospital in 2016 was 60.39, which was significantly higher than the average of 51.20% in 2015, and the difference was statistically significant after independent sample T test (P0.05). The clinical pathway of atrial fibrillation in cardiovascular department was the highest in the rate of entry (positive index) after screening. The clinical pathway of colonic polyp in digestive department was the lowest in average drug cost (negative index) and the rank sum test (P0.05) was the lowest in each clinical pathway, and the difference was statistically significant. Conclusion: the results of this study show that the overall evaluation of clinical path management in empirical hospitals in 2016 is superior to that in 2015. The efficiency of the clinical pathway implementation process was improved, in which the disease entry rate and the path completion rate were improved, but the path completion rate was not high, and the path variation rate was higher and increased. Therefore, the early management and the later summary of clinical pathway implementation should be strengthened. Improve the executive ability of clinical pathway management. The effect of clinical path implementation has achieved good development, the average hospitalization days have been continuously reduced, the mortality rate has been controlled steadily, the clinical path curative effect has been more up to standard, but the readmission rate has increased slightly, so we should further standardize the diagnosis and treatment process and improve the quality of medical treatment. Chinese medicine has been widely used in clinical path management, but the cost of traditional Chinese medicine is not high, so we should further highlight the advantages of traditional Chinese medicine in the implementation of clinical pathway. Improve the social and economic benefits of traditional Chinese medicine. The cost of controlling medical consumables is good, but the average cost of medical treatment is rising, so we should further standardize the process of diagnosis and treatment, strengthen the monitoring of hospital expenses and drug expenses, and the information construction of clinical path is not perfect. It is still necessary to combine the clinical pathway with the electronic medical record effectively and focus on the systematic path management. In addition, the clinical pathway of atrial fibrillation was the highest in the clinical pathway management of empirical hospital in 2016, and the clinical pathway of colorectal polyp was the best to control the drug cost.
【学位授予单位】：广州中医药大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R197.4

【参考文献】