实施临床路径对老年性白内障手术患者住院费用和住院日影响的比较研究

发布时间：2018-08-04 17:14

【摘要】：研究背景医疗资源配置不合理和医疗费用过快上升造成的"看病难、看病贵",是目前社会关注的焦点问题,也是我国医疗卫生体制改革的重点和难点。临床路径在20世纪70年代早期产生于美国医疗费用急速上涨的背景下,在控制医疗费用、缩短平均住院日等方面体现了优越性。在我国深化医药卫生体制改革的进入深水期后,临床路径已逐步成为我国控制医疗费用、提高医疗效率、规范诊疗行为的重要管理形式。白内障是世界上首位致盲眼病,每年我国因白内障致盲的就有250多万人,其中老年性白内障是最主要的类型。目前对于白内障的治疗缺乏有效的药物,手术仍是唯一有效的治疗方法。超声乳化白内障摘除术联合人工晶体植入术(IOL)(13.41+13.71)是最普遍的手术方式。老年性白内障(H25.901)作为常见病、单病种付费病种,治疗过程相对固定,患者受变异因素影响相对较少,适合作为临床路径病种。本研究所涉及安徽省某三级甲等医院自2016年1月1日起,对老年性白内障实施全面的临床路径管理。研究目的1.在临床路径信息化基础上,多部门协同完成老年性白内障行超声乳化白内障摘除术联合人工晶体植入术临床路径表单的制定;2.通过比较安徽省某三级甲等医院眼科实施临床路径管理前后,老年性白内障行超声乳化白内障摘除术联合人工晶体植入术病例住院期间各项费用、住院日等指标的变化,讨论实施临床路径对控制医疗费用、缩短住院日的作用。资料与方法本研究以安徽省某三级甲等医院眼科为研究机构,该医院眼科为本研究提供了充足的研究病例。本项研究患者纳入标准为:2015年4月至2016年9月行超声乳化白内障摘除术联合人工晶体植入术的老年性白内障病例。该医院从2016年1月1日起对老年性白内障实施临床路径管理,2015年4月至2015年12月的老年性白内障病例均未进行临床路径管理,2016年1月至2016年9月的老年性白内障病例均按照临床路径进行管理。本研究通过对实施临床路径前后老年性白内障病例的平均住院费用、平均药品费用、平均材料费用、平均手术费用、平均检查费用、平均住院日、各项费用比例等指标进行比较分析,研究实施临床路径对老年性白内障病例上述指标的影响。利用该医院HIS(Hospital Information System)系统、临床路径软件等导出相关数据;利用电子病历系统等辅助进行病例筛选;利用Excel2007建立数据库;采用SPSS19.0统计学软件对该次研究所得数据进行统计学处理和分析,计量资料采用χ2±s,计数资料采用率描述,统计学方法采用t检验、卡方检验进行统计学分析,以P0.05为差异有统计学意义。主要结果通过统一的纳入标准和排除标准筛选符合要求的病例共1294例,其中对照组651例,路径组643例。路径组和对照组进行对比分析,路径组的平均住院费用相较对照组下降200.48 元(t=3.783,P=0.000);平均住院日下降 0.63 天(t=5.516,P=0.031);平均药品费用下降 75.5 元(t=4.694,P=0.000);平均检查费用下降 96.89 元(t=6.772,P=0.008);平均手术费用下降63.52元(t=4.108,P=0.000),差异均有统计学意义。从各项费用比例来看,路径组平均药品费用占比为7.47%,对照组为8.28%(P0.05);路径组患者的检查费用占比较对照组占比下降了 1.31%(P0.05),差异有统计学意义。路径组平均材料费用占比为18.61%,对照组为18.93%(P0.05);两组患者的手术费用占比相比较,路径组低0.09%(P0.05),差异没有统计学意义。路径组与对照组相比,平均每床日费用上升了 110.66元(t=-6.214,P0.05),差异有统计学意义。结论1.通过实施临床路径管理管理,老年性白内障行超声乳化白内障摘除术联合人工晶体植入术患者的平均住院费用、平均药品费用、平均检查费用、平均手术费用均明显降低。2.实施临床路径管理后,老年性白内障行超声乳化白内障摘除术联合人工晶体植入术患者的平均住院日下降了 0.63天,有效提高了床位周转率,提高了医疗效率。
[Abstract]:The problem of "difficulty in seeing a doctor and expensive to see a doctor" caused by the irrational allocation of medical resources and the rapid rise of medical expenses is the focus of social concern at present. It is also the focus and difficulty of the reform of medical health system in China. In the early 1970s, the medical cost was controlled in the background of the rapid rise in the cost of medical treatment in the United States and the control of medical expenses. After the deepening of the medical and health system reform into the deep water period, the clinical path has gradually become an important management form to control medical expenses, improve medical efficiency and standardize the behavior of diagnosis and treatment in our country. Cataract is the first blind eye disease in the world, and every year our country is blinded by cataract There are about 2500000 people, of which senile cataract is the most important type. There is no effective medicine for the treatment of cataract. Surgery is still the only effective treatment. Phacoemulsification and intraocular lens implantation (IOL) (13.41+13.71) are the most common surgical methods. Senile cataract (H25.901) is a common disease. The treatment process is relatively fixed, the patients are relatively less affected by the variation factors and suitable for the clinical pathway disease. This study involves the implementation of a comprehensive clinical path management for senile cataracts since January 1, 2016 in a three grade a hospital in Anhui province. Research objective 1. on the basis of clinical pathway information, multiple departments are on the basis of clinical pathway information. The clinical pathway form of phacoemulsification combined with intraocular lens implantation for senile cataract was completed. 2. by comparing the clinical path management of the ophthalmology in a certain three grade hospital in Anhui Province, phacoemulsification and intraocular lens implantation in the elderly patients were hospitalized. The changes in the cost and hospitalization days were discussed, and the effect of the clinical pathway on the control of medical expenses and shortening the hospitalization days was discussed. The data and methods were studied by the ophthalmology of a class three grade a hospital in Anhui province. The ophthalmology of the hospital provided sufficient research cases for this study. The criteria for this study were from April 2015 to 20. In September 16 years, phacoemulsification and intraocular lens implantation combined with intraocular lens implantation was performed. The hospital carried out clinical pathway management for senile cataracts from January 1, 2016. No clinical pathway management was carried out in the cases of senile cataract from April 2015 to December 2015, and the aged from January 2016 to September 2016 was white. All cases of cataract were managed according to the clinical path. This study compared the average hospitalization expenses, average drug cost, average cost of material, average cost of operation, average cost of inspection, average hospitalization day, and all the expenses compared with the cases before and after the implementation of the clinical pathway. The influence of the above indexes in senile cataract cases. Related data were derived from the HIS (Hospital Information System) system, clinical path software and so on. The case screening was carried out with the aid of the electronic medical record system and so on; the database was established by Excel2007; the statistical data of this study was carried out by the SPSS19.0 statistical software. Theory and analysis, the measurement data were described by chi 2 + s, statistical data use rate description, statistical method using t test, chi square test for statistical analysis, P0.05 as the difference was statistically significant. The main results through the unified inclusion criteria and exclusion criteria for screening a total of 1294 cases of disease cases, including 651 cases in the control group and 643 cases in the path group. The average hospitalization cost in the path group was 200.48 yuan (t=3.783, P=0.000) compared with the control group, and the average hospitalization day decreased by 0.63 days (t=5.516, P=0.031); the average drug cost decreased by 75.5 yuan (t=4.694, P=0.000); the average inspection cost decreased by 96.89 yuan (t=6.772, P=0.008), and the average operation cost decreased by 63.52 yuan. (t=4.108, P=0.000), the difference was statistically significant. The average cost ratio of the route group was 7.47% and the control group was 8.28% (P0.05). The examination cost of the patients in the path group was 1.31% (P0.05) in the comparison group (P0.05). The difference has the significance of the overall planning. The average material cost ratio of the path group was 18.61% and the control group was 1. 8.93% (P0.05); the cost of operation in the two group was compared to the comparison, the path group was lower 0.09% (P0.05), the difference was not statistically significant. Compared with the control group, the average daily cost of each bed increased by 110.66 yuan (t=-6.214, P0.05), the difference was statistically significant. Conclusion 1. through the implementation of clinical path management management, senile cataract with phacoemulsification After cataract extraction and intraocular lens implantation, the average cost of hospitalization, the average drug cost, the average cost of examination, the average cost of the operation were significantly reduced by the.2. clinical pathway management. The average hospitalization day of senile cataract with phacoemulsification combined with intraocular lens implantation decreased by 0.63 days. It improves the turnover rate of the bed and improves the medical efficiency.
【学位授予单位】：山东大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R779.66;R197.323

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