摘要
目的对国内实施膝关节镜手术临床路径的卫生经济学效果进行评价,探讨临床路径对膝关节镜手术患者的平均住院天数、平均住院费用和患者满意度的影响。方法通过计算机检索中国生物医学文献服务系统(SinoMed,1978年1月—2012年6月)、中国期刊全文数据库(CNKI,1994年1月—2012年6月)和万方数据库(1990年1月—2012年6月),中文检索词包括:膝关节、膝关节镜、关节镜检查、关节镜手术、临床路径,收集膝关节镜手术临床路径卫生经济学效果评价的研究。根据事先制定的纳入和排除标准选择文献,采用Note Express 2.8软件进行查重,阅读全文提取资料,并按照Newcastle-Ottawa文献质量评价量表(NOS)对纳入文献进行方法学质量评价,采用RevMan 5.1软件进行Meta分析。结果共纳入7篇文献(730例患者,其中临床路径组373例,对照组357例),NOS评分均为4分。其中2篇是随机对照研究,5篇是病例对照研究。Meta分析结果显示,临床路径组与对照组比较,其平均住院天数减少〔均数差(MD)=-3.22,95%CI(-4.72,-1.72)〕,平均住院费用减少〔MD=-730.04,95%CI(-1 054.56,-405.52)〕,患者满意度增加〔MD=6.04,95%CI(3.30,8.77)〕,差异均有统计学意义。按照随机对照研究和病例对照研究进行亚组分析,亦得出上述结果。平均住院天数的研究发表偏倚不明显,但平均住院费用的研究存在明显的发表偏倚。结论在我国,实施膝关节镜手术临床路径尚未明确能够缩短平均住院天数、减少平均住院费用和提高患者满意度,需要进一步开展高质量的研究。
Objective To evaluate the healthcare economics effect of arthroscopic surgery clinical pathway （CP） in China and to discuss the influence of CP on the average hospital stay, average expenditure and satisfactory levels in arthroscopic surgery. Methods The following databases such as SinoMed （1978. 1--2012. 6）, CNKI （1994. 1--2012. 6） and Wanfang （1990. 1--2012. 6） were searched to collect the literatures about knee arthroseopic surgery clinical pathway. The Chinese key words were： knee, knee arthroscopy, arthroscopy, arthroscopic surgery and clinical path. Studies on arthroscopic surgery clini- cal path healthcare economics effect were collected. According to the pre - established inclusion and exclusion criteria, data were extracted through reading the full text by using Note Express 2. 8 software to check the weight. The quality of the included studies was evaluated according to Newcastle - Ottawa Scale （ NOS ） . Meta - analyses were performed by using RevMan 5.1 soft- ware. Results A total of seven studies involving 730 cases were included, of which 373 cases were in the clinical pathway group while the other 357 cases were in the control group. According to the NOS, all the seven studies were four points. Two studies were randomized controlled trials （RCTs） and five studies were case control studies. The results of Meta - analyses indicated that com- pared with control group, the clinical pathway group had shorter hospital stay [ MD = -3.22, 95% CI （ -4. 72, - 1.72） ] and less expenditures [ MD = - 730. 04, 95% CI （ - 1 054. 56, - 405.52 ） ] and increased patients＇ satisfaction [ MD = 6.04, 95% CI （3.30, 8.77） ] . The results of Meta - analyses with RCTs and case control studies as subgroups got the sameresults. Although there were statistically significant differences, but there were heterogeneity and publication bias, especially in the average hospital expenditures. Conclusion In China, we cannot conclude that knee arthroscopic surgery clinical pathway can shorten hosp
出处
《中国全科医学》
CAS
CSCD
北大核心
2013年第28期3366-3370,共5页
Chinese General Practice
基金
北京市教育委员会社科计划面上项目(SM201110025003)
北京市属高等学校人才强教深化计划"中青年骨干人才培养计划"项目
北京市优秀人才培养资助项目(2010年度)
关键词
临床路径
经济学
医学
膝关节镜手术
META分析
Clinical pathways
Economics, medical
Knee arthroscopic surgery
Meta analysis
