摘要
目的以国家临床路径为评价标准,研究我国公立综合医院常见病种/手术住院诊疗的规范性。方法以社区获得性肺炎、急性心肌梗死、急性左心功能衰竭、计划性剖宫产和胆囊结石合并急性胆囊炎行胆囊切除术为代表,在上海市、湖北省、甘肃省共18所公立综合医院进行病案评阅,分析上述5种病种/手术的临床路径符合率。结果 2 521份病案评阅显示,我国公立综合医院上述5种病种/手术住院诊疗的临床路径总体诊疗符合率为69.48%;并且社区获得性肺炎的平均诊疗符合率较低,上海市的平均诊疗符合率相对较高,三级公立综合医院高于二级公立综合医院。结论建议完善临床路径实施的激励机制、内外部监管以及医院资源配置,提高常见病种和手术诊疗的规范性。
Objective To investigate the normative status of inpatient medical care with corresponding national clinical pathways for inpatients with common diseases/operations in China’s public general hospitals.Methods Community-acquired pneumonia,acute myocardial infarction,acute left ventricular failure,planned caesarean section,and gallstones associated with acute cholecystitis for cholecystectomy were taken as representatives.Medical records from 18 public general hospitals located in Shanghai,Hubei Province and Gansu Province were audited,and the agreement rate with clinical pathway were analyzed.Results The average agreement rate of five common diseases/operations was 69.48%based on the audits of 2 521 medical records.The agreement rate of community-acquired pneumonia was lower compared with other conditions,public general hospitals in Shanghai had higher agreement rate than other two provinces,and tertiary general hospitals had higher agreement rate than secondary general hospitals.Conclusion It is suggested to improve the incentive mechanism,internal and external supervision and the allocation of hospital resources to increase the standardization of hospitalization for common diseases/operations.
作者
白飞
白洁
汤慧芹
魏雪峰
周萍
薛迪
BAI Fei;BAI Jie;TANG Hui-qin;WEI Xue-feng;ZHOU Ping;XUE Di(Medical Management Service Guidance Center,National Health Commission of the People’s Republic of China,Beijing 100044,China;School of Public Health,Fudan University,Key Lab of Health Technology Assessment,National Health Commission of the People’s Republic of China,Shanghai 200032,China;Medical Administration Division,Health and Family Planning Commission of Hubei Province,Wuhan 430079,Hubei China;Medical Administration Division,Health and Family Planning Commission of Gansu,Lanzhou 730030,Gansu China)
出处
《中国卫生资源》
北大核心
2018年第5期383-387,共5页
Chinese Health Resources
基金
国家自然科学基金面上项目(71473047)
美国中华医学会基金(13-153)。
关键词
临床路径
医疗质量
过程质量
过程评价
公立医院
clinical pathway
medical quality
process quality
process assessment
public hospital
