[1]古德彬,李梦滢,沈际勇.临床路径管理对脑梗死患者住院费用的影响研究[J].卫生经济研究,2023,40(6):30-34.
 GU Debin,LI Mengying,SHEN Jiyong.Study on the Influence of Clinical Pathway Management on Hospitalization Expenses of Patients with Cerebral Infarction[J].Journal Press of Health Economics Research,2023,40(6):30-34.
点击复制

临床路径管理对脑梗死患者住院费用的影响研究
分享到:

卫生经济研究[ISSN:1004-7778/CN:33-1056/F]

卷:
40
期数:
2023年6期
页码:
30-34
栏目:
疾病经济负担
出版日期:
2023-06-05

文章信息/Info

Title:
Study on the Influence of Clinical Pathway Management on Hospitalization Expenses of Patients with Cerebral Infarction
作者:
古德彬1李梦滢2沈际勇2
1.清华大学附属北京清华长庚医院/清华大学临床医学院,北京102218
2.清华大学医院管理研究院,广东 深圳 518055
Author(s):
GU Debin LI Mengying SHEN Jiyong
Beijing Tsinghua Changgung Hospital, Tsinghua University, Beijing 102218, China
关键词:
脑梗死临床路径住院费用
Keywords:
cerebral infarction clinical pathway hospitalization expenses
分类号:
R19
文献标志码:
A
摘要:
目的:探讨临床路径管理对脑梗死患者住院费用的影响。方法:利用S医院因脑梗死入院的患者病案首页数据,进行方差分析、卡方检验和多元线性回归分析。结果:影响临床路径入组的因素仅有疾病分型,控制其他因素影响后,临床路径组住院费用比非临床路径组高1 767.17元(P=0.028)、药费高1 423.83元(P<0.001),但医嘱离院占比无显著变化、平均住院日和住院费用的变异系数降低,临床路径调节疾病特征对住院费用影响的效应不显著。结论:临床路径管理侧重于提质而非增效,并不必然带来医疗费用降低,要多措并举推动临床路径管理高质量落地。
Abstract:
Objective To explore the influence of clinical pathway management on hospitalization expense of patients with cerebral infarction. Methods By the data on the first page of medical records of 1 078 patients in S hospital in 2019, analysis of variance, chi-square test and multiple linear regression analysis were used. Results The only factor affecting the clinical pathway implementation was the subtypes of disease. After controlling effects of other factors, the hospitalization expenses of the clinical pathway group was 1 767.17 yuan higher than that of the non-clinical pathway group(P=0.028). Among them, the drug cost of the clinical pathway group was 1 423.83 yuan higher than that of the non-clinical pathway group(P<0.001), but there was no significant change in the proportion of medical advice to leave the hospital, the coefficient of variation of average hospitalization days and hospitalization expenses decreased, and the effect of clinical pathway regulating disease characteristics on hospitalization expenses was not significant. Conclusion Clinical pathway management focuses on improving quality rather than increasing efficiency, which does not necessarily lead to a reduction in medical expenses. Multiple measures should be taken to promote the high-quality implementation of clinical pathway management.

参考文献/References:

[1] 刘东东.全面深化医疗卫生体制改革保障人民健康[J].黑龙江医学,2016,40(S1):24-25.
[2]国家卫生计生委临床路径管理工作媒体沟通会文字实录[EB/OL].(2017-08-17)[2022-03-27].http://www.nhc.gov.cn/xcs/s3574/201708/a3ea7d5f6efa4a44bf338f1d55e60749.shtml.
[3] 关翎,郭昱君,杨燕绥,等.临床路径优化卫生资源的分析研究[J].中国卫生质量管理,2020,27(1):39-43.
[4] 陈维雄,林雯琦,欧凡,等.DIP与临床路径对医疗资源消耗影响的实证研究[J].中国医疗保险,2021(3):56-61.
[5] 王琨,蒋雷,张灿宏,等.基于DRGs的临床路径住院费用分析[J].中国卫生质量管理,2019,26(4):28-30.
[6] Kullgren K A,Klein E J,Sturza J,et al.Standardizing pediatric somatic symptom and related disorders care:clinical pathway reduces health care cost and use[J].Hosp Pediatr,2020,10(10):867-876.
[7] Porter G A,Pisters P W,Mansyur C,et al.Cost and utilization impact of a clinical pathway for patients undergoing pancreaticoduodenectomy[J].Ann Surg Oncol,2000,7(7):484-489.
[8] 《中国脑卒中防治报告2019》概要[J].中国脑血管病杂志,2020,17(5):272-281.
[9] 国家卫生计生委办公厅关于实施苯丙酮尿症等26个病种临床路径的通知[EB/OL].(2016-06-12)[2022-03-27].http://www.nhc.gov.cn/yzygj/s3593/201606/f463147f6218436ba6ceb8190e1933ca.sh tml.
[10] 国家中医药管理局办公室关于印发中风病(脑梗死)等92个病种中医临床路径和中医诊疗方案(2017年版)的通知[EB/OL].(2017-03-22)[2022-03-27].http://www.satcm.gov.cn/yizhengsi/g ongzuodongtai/2018-03-24/2651.html.
[11] Ondeck N T,Bovonratwet P,Ibe I K,et al.Discriminative ability for adverse outcomes after surgical management of hip fractures:a comparison of the charlson comorbidity index,elixhauser comorbidity measure,and modified frailty index[J].J Orthop Trauma,2018,32(5):231-237.
[12] 曾莉瑾,廖文婷.基于临床路径的病种费用与控费效果分析[J].医院管理论坛,2022,39(3):20-22,82.

相似文献/References:

[1]裴 敬,周晓容,李家伟,等.新农合单病种支付方式改革现状与对策研究[J].卫生经济研究,2017,(01):32.
[2]肖云芳,何 宇,杨小丽.医养结合发展热潮的冷思考[J].卫生经济研究,2017,(08):22.
[3]于保荣.按病例支付及医疗服务支付方式改革的实现条件——从DRGs、按病种付费、点数法付费及临床路径谈起[J].卫生经济研究,2018,(09):16.
 YU Bao-rong.Conditions for the Implementation of Reforms by Case Payment and Payment for Medical Services ——From DRGs,Case-based payments,Point payments,and Clinical pathways[J].Journal Press of Health Economics Research,2018,(6):16.
[4]张文娟,宋厚斌,王新虹,等.基于临床路径的按病种付费分段控制标准化构建[J].卫生经济研究,2019,(07):36.
 ZHANG Wen-juan,SONG Hou-bin,WANG Xin-hong,et al.Standardized Construction of Disease-based Segmentation Control Based on Clinical Path[J].Journal Press of Health Economics Research,2019,(6):36.
[5]陈佳颖,吴丹枫.医院病种成本核算方法研究及应用[J].卫生经济研究,2020,(03):46.
 CHEN Jia-ying,WU Dan-feng.Research and Application of Hospital Disease Cost Accounting Method[J].Journal Press of Health Economics Research,2020,(6):46.
[6]向 前,吴荣海,吴伟旋,等.基于临床路径的病种标准成本核算研究[J].卫生经济研究,2020,(10):66.
 XIANG Qian,WU Rong-hai,WU Wei-xuan,et al.Research on the Standard Cost Accounting of Disease Based on Clinical Pathway[J].Journal Press of Health Economics Research,2020,(6):66.
[7]李梦滢,孙志成,唐 尧,等.基于DRG的公立医院临床路径管理体系建设[J].卫生经济研究,2022,39(2):67.
 LI Meng-ying,SUN Zhi-cheng,TANG Yao,et al.Construction of Clinical Pathway Management System in Public Hospitals Based on DRG[J].Journal Press of Health Economics Research,2022,39(6):67.
[8]纪 门,孔旭辉,黄秀芹,等.DRG高倍率病例特征分析及管理建议[J].卫生经济研究,2023,40(1):78.
 JI Men,KONG Xuhui,HUANG Xiuqin,et al.Cause Analysis and Policy Optimization of DRG High-Rate Cases[J].Journal Press of Health Economics Research,2023,40(6):78.
[9]陈志军,包维晔,沈思远,等.基于临床路径的儿科病种成本收益研究[J].卫生经济研究,2023,40(8):49.
 CHEN Zhijun,BAO Weiye,SHEN Siyuan,et al.Study on Cost and Benefit of Pediatric Diseases based on Clinical Pathway[J].Journal Press of Health Economics Research,2023,40(6):49.
[10]王玉廷,阳文琳.公立医院DRG临床路径管控方案探索及效果评价[J].卫生经济研究,2024,41(07):71.
 WANG Yuting,YANG Wenlin.Exploration and Effect Evaluation of DRG-based Clinical Pathway Control Program in Public Hospitals[J].Journal Press of Health Economics Research,2024,41(6):71.

更新日期/Last Update: 2023-06-05