摘要
目的:应用医院病例数据评价临床路径对腹腔镜胆囊切除手术患者医疗资源使用的管理效果。方法:采集深圳市7家公立医院2015年12月—2016年9月的病案首页,研究对象为第一诊断是胆囊结石伴慢性胆囊炎(ICD10:K80. 1)且行腹腔镜胆囊切除手术(ICD-9-CM:51. 23)。统计分析方法采用独立t检验、卡方检验以及广义线性回归分析。结果:共有932例符合研究对象的定义,其中路径组696例,平均住院天日7. 15天,住院费用15 181. 5元;非路径组236例,平均住院天日9. 42天,住院费用19 774. 8元。校正其他影响因素后,路径组的住院天日比非路径组少1. 51天(P <0. 001),住院费用少3 818元(P <0. 001)。结论:患者的疾病状况虽然是影响住院天日与住院费用的重要因素,但本研究发现临床路径实施对腹腔镜胆囊切除患者的医疗质量与医疗资源管理具有影响,建议未来有更多实证研究检验临床路径效果,以供相关政策参考。
Objective:To evaluate the effects of clinical pathway on patients have undergone the laparoscopic cholecystectomy on the utilization of medical resources using the hospital case data.Methods:The medical records of the seven public hospitals in Shenzhen from December 2015 to September 2016 were collected.The first diagnosis tracked 932 patients who were identified as chronic cholecystitis with gallbladder stones(ICD10:K80.1)and received laparoscopic cholecystectomy(ICD-9-CM:51.23).Patients were classified into two groups,namelyclinical pathway group(CP)as independent variables and non-clinical pathway group(Non-CP)as dependent variables.The length of stay and hospital expenses would be compared between these two groups.The controlvariables includedpatients'demographic characteristics,disease emergency and severity.The statistical analysis methods included the independent T test,Chi-squareχ2 test,and generalized linear regression analysis GLM.Results:A total of 932 patients were eligible for the study,including 696 in the clinical pathway group and 236 in the non-clinical pathway group.After adjusted control variables,the length of hospital stays and hospitalization costs in the CP group(an average of 7.15 days,15181.5RMB)were both significantly lower than the Non-CP group(9.42 days,19774.8RMB).After adjusting for other influencing factors,the hospitalization days in the CP group were 1.15 days less than those in the Non-CP group(P<0.001),and the hospitalization expenses were 3818 RMB(P<0.001)respectively.In both CP group andNon-CP group,the length of stay and hospital expenses of patients who were emergentlyadmitted or who received surgery and/or with comorbidity were higher compared toother patients.Conclusions:Although the diseases status of patientsconstitute the most important factors affecting the health care resources utilization,this study found that the clinical pathway implementation has a meaningful impact on the medical quality and medical resources management for patients undergoing the laparoscopic cholecystectomy.It is recommended that the government should provide policy to encourage hospitals and physicians to apply the clinical pathway and that there should be more empirical research in the future.
作者
郭昱君
关翎
邱亨嘉
杨燕绥
KUO Yu-chun;GUAN Ling;CHIU Herng-chia;YANG Yan-sui(Institute for Hospital Management,Tsinghua University,Shenzhen Guangdong 518055,China;School of Public Health,The Johns Hopkins University,Baltimore Maryland MD4321,USA;School of Public Policy and Management,Tsinghua University,Beijing 100084,China)
出处
《中国卫生政策研究》
CSCD
北大核心
2018年第8期50-55,共6页
Chinese Journal of Health Policy
关键词
临床路径
胆结石伴慢性胆囊炎
住院天日
住院费用
资源使用
Clinical pathway
Cholecystitis with gallbladder stones
Length of stay
Hospitalization expenses
Resource utilization
作者简介
郭昱君,女,博士后,主要研究方向为卫生政策评估、卫生经济分析、医疗服务管理等。E-mail:yuchunkuo@sz.tsinghua.edu.cn;通讯作者:邱亨嘉。E-mail:chiuhc@sz.tsinghua.edu.c
