基于计划性剖宫产临床路径病种医疗质量控制的可行性研究

发布时间：2018-06-08 12:34

  本文选题：临床路径 + 单病种医疗质量控制　； 参考：《新疆医科大学》2014年硕士论文

【摘要】：目的：通过应用卫生部《病种质量控制标准》的指标,对样本医院计划性剖宫产临床路径的实施效果进行分析,观察在现有的临床路径管理模式下,是否能控制不规范临床诊疗行为。探索临床路径管理模式与单病种质量控制有机结合的可行性和方法。方法：通过文献研究法和样本医院临床路径实施情况资料,了解计划性剖宫产临床路径和该病种医疗质量控制的实施现状和难点；采用系统随机抽样的方法,对照研究实施(观察组)与未实施(对照组)临床路径管理的计划性剖宫产患者的住院疗程、诊疗合理性、医疗费用、患者满意度等相关指标变化,评价实施该病种临床路径控制医疗质量的效果,寻找进一步完善临床路径的方法；采用SPSS13.0统计软件包处理数据,两组间比较采用t检验,计数资料采用χ2检验；将收集到的各类数据分类输入Excel数据库中进行计算,使用SPSS13.0分析软件对病种医疗质量相关指标进行描述性统计分析。结果：实施计划性剖宫产临床路径后产妇住院天数、术后住院日均明显缩短,药费降低而且患者对医疗质量的满意度提高,社会因素为手术指征的剖宫产率降低,且观察组与对照组间比较,差异均有统计学意义(p0.05)。新生儿窒息率、产后出血发生率、总住院医疗费、手术切口Ⅱ甲愈合率,组间比较差异均无统计学意义(P0.05)),但两组指标均在控制目标范围内。结论：计划性剖宫产临床路径的实施降低了住院天数和术后住院日,相对提高了医疗服务效率；患者满意度提高,在一定程度上改善了医患关系；药费明显降低,相对控制了不合理用药尤其是滥用抗生素的问题；患者及家属要求的剖宫产手术比率降低,在一定程度上控制了剖宫产率,提高了产科质量。临床路径管理模式下能对已经较规范的诊疗行为起到继续督导、控制的作用。进行医疗质量控制还需要注意很多细节,还有很多地方需要完善,只有有效利用信息系统,建立一个便于操作和执行的,适合病种特点和符合医院实际的,科学的临床路径实施、评价及管理体系,才能真正实现其医疗质量控制和管理的作用。
[Abstract]:Objective: to analyze the effect of clinical route of planned cesarean section in a sample hospital by applying the index of quality control standard of disease species in Ministry of Health, and observe the effect of clinical path management mode. Whether can control nonstandard clinical diagnosis and treatment behavior. To explore the feasibility and method of combining clinical pathway management mode with single disease quality control. Methods: by means of literature research and the data of clinical path implementation in the sample hospital, the present situation and difficulties of clinical route and medical quality control of planned cesarean section were investigated, and the method of systematic random sampling was used. The changes of hospitalization course, rationality of diagnosis and treatment, medical cost and patient satisfaction of planned cesarean section patients with and without clinical path management were studied in the control group and the control group, respectively. To evaluate the effect of implementing the clinical pathway to control the quality of medical treatment, to find a way to further improve the clinical pathway, to use SPSS 13.0 statistical software package to process the data, to compare the data between the two groups by t test, and to use 蠂 2 test to count the data. The collected data were classified into Excel database for calculation, and SPSS 13.0 analysis software was used to analyze the related indexes of medical quality. Results: after the clinical route of planned cesarean section was carried out, the days of hospitalization were significantly shortened, the cost of medicine was reduced, and the patients' satisfaction with the quality of medical treatment was improved, and the rate of cesarean section, which was indicated by social factors, was decreased. The difference between the observation group and the control group was statistically significant (P 0.05). The rate of neonatal asphyxia, the incidence of postpartum hemorrhage, the total hospitalization expenses, the healing rate of operation incision 鈪，

本文编号：1995807