本文選題：臨床路徑 + 管理�。� 參考：《廣州中醫(yī)藥大學(xué)》2017年碩士論文

【摘要】：目的:本文通過(guò)梳理和總結(jié)臨床路徑管理評(píng)價(jià)經(jīng)驗(yàn),遴選出一套能夠科學(xué)、有效的評(píng)價(jià)中醫(yī)院臨床路徑管理的指標(biāo),對(duì)廣東省某三甲中醫(yī)院進(jìn)行實(shí)證研究,評(píng)價(jià)中醫(yī)院的臨床路徑實(shí)施過(guò)程和實(shí)施效果情況,找出中醫(yī)院臨床路徑管理模式中存在的問(wèn)題并提出對(duì)策,從而加強(qiáng)醫(yī)院醫(yī)務(wù)人員對(duì)中醫(yī)院臨床路徑工作的注重,進(jìn)一步促進(jìn)和提升中醫(yī)院臨床路徑管理水平。方法:本研究首先結(jié)合課題研究成果,通過(guò)查閱大量相關(guān)參考文獻(xiàn),初步遴選出一套科學(xué)性好、權(quán)威性高、適用性強(qiáng)的臨床路徑管理評(píng)價(jià)指標(biāo)體系。第二,通過(guò)專(zhuān)家訪談,對(duì)課題組專(zhuān)家及廣東省中醫(yī)院項(xiàng)目療效辦負(fù)責(zé)人等專(zhuān)家,就如何科學(xué)有效的評(píng)價(jià)中醫(yī)院臨床路徑實(shí)施過(guò)程和實(shí)施效果進(jìn)行交流訪談,為遴選合適的、可操作性的中醫(yī)院臨床路徑管理評(píng)價(jià)指標(biāo)指明方向。第三,對(duì)廣東省某三甲中醫(yī)院進(jìn)行實(shí)證研究,調(diào)查收集各指標(biāo)條目統(tǒng)計(jì)數(shù)據(jù),采用對(duì)比分析法,對(duì)該醫(yī)院2015年度、2016年度臨床路徑管理實(shí)施效果進(jìn)行總體分析,并對(duì)2016年度該醫(yī)院的臨床路徑管理實(shí)施情況進(jìn)行各臨床路徑之間對(duì)比,分析探尋最優(yōu)臨床路徑。結(jié)果:確定了評(píng)價(jià)中醫(yī)院臨床路徑管理實(shí)施情況的15個(gè)指標(biāo),對(duì)廣東省某中醫(yī)院進(jìn)行實(shí)證研究,結(jié)果顯示,實(shí)證醫(yī)院2016年度臨床路徑管理的病種入徑率均值為60.39%,比2015年度均值51.20%有明顯提高,且經(jīng)過(guò)獨(dú)立樣本T檢驗(yàn),P0.05,差異具有統(tǒng)計(jì)學(xué)意義;在各臨床路徑分組中,心血管科的心房顫動(dòng)臨床路徑在篩選后的兩兩比較病種入徑率(正向指標(biāo))中秩均值最高,消化科的大腸息肉臨床路徑在各個(gè)臨床路徑的對(duì)比分析中次均藥品費(fèi)用(負(fù)向指標(biāo))的平均秩次最低,且秩和檢驗(yàn)P0.05,具有顯著性差異,差異具有統(tǒng)計(jì)學(xué)意義。結(jié)論:本研究結(jié)果顯示,實(shí)證醫(yī)院2016年度臨床路徑管理整體評(píng)價(jià)比2015年度優(yōu)越。臨床路徑實(shí)施過(guò)程效率得到提升,其中病種入徑率和路徑完成率均有所提高,但路徑完成率不高,路徑變異率較高且有所增長(zhǎng),應(yīng)加強(qiáng)臨床路徑實(shí)施的前期管理與后期總結(jié),提高臨床路徑管理執(zhí)行力。臨床路徑實(shí)施效果取得良好發(fā)展,平均住院日持續(xù)降低,病死率穩(wěn)步控制,臨床路徑療效更為達(dá)標(biāo),但再入院率有微幅增長(zhǎng),應(yīng)進(jìn)一步規(guī)范診療過(guò)程和提高醫(yī)療質(zhì)量。中醫(yī)藥運(yùn)用全面加強(qiáng),中藥飲片、中成藥和中醫(yī)特色療法在臨床路徑管理中得到廣泛使用,但中醫(yī)藥費(fèi)用占比不高,應(yīng)在臨床路徑實(shí)施中進(jìn)一步突出中醫(yī)藥特色優(yōu)勢(shì),提升中醫(yī)藥的社會(huì)效益和經(jīng)濟(jì)效益。醫(yī)用耗材控費(fèi)良好,但平均醫(yī)療費(fèi)用有所上漲,應(yīng)進(jìn)一步規(guī)范診療過(guò)程,加強(qiáng)住院費(fèi)用及藥品費(fèi)用的監(jiān)控;臨床路徑信息化建設(shè)不完善,仍需要將臨床路徑與電子病歷有效結(jié)合,重點(diǎn)做好系統(tǒng)的路徑管理環(huán)節(jié)。此外,2016年實(shí)證醫(yī)院臨床路徑管理中,心房顫動(dòng)臨床路徑的病種入徑率最高,大腸息肉臨床路徑對(duì)藥品費(fèi)用控制最好。
[Abstract]:Objective: through combing and summing up the experience of clinical path management evaluation, this paper selected a set of scientific and effective indicators to evaluate the clinical path management of traditional Chinese medicine hospitals, and carried out an empirical study on one of the top three traditional Chinese medicine hospitals in Guangdong Province. To evaluate the process and effect of clinical path implementation in Chinese medicine hospital, to find out the problems existing in the clinical path management mode of traditional Chinese medicine hospital and to put forward countermeasures, so as to strengthen the attention of medical staff to clinical path work in Chinese medicine hospital. To further promote and enhance the level of clinical path management in Chinese medicine hospitals. Methods: based on the research results, a set of scientific, authoritative and applicable evaluation index system of clinical path management was preliminarily selected by consulting a large number of relevant references. Second, through the expert interview, the experts of the research group and the head of the project curative effect office of Guangdong traditional Chinese medicine hospital, etc., exchange interviews on how to scientifically and effectively evaluate the implementation process and effect of the clinical path of the traditional Chinese medicine hospital, so as to select the appropriate one. The operable evaluation index of clinical path management in Chinese medicine hospital indicates the direction. Thirdly, an empirical study was carried out on a top three Chinese medicine hospital in Guangdong province. The statistical data of each index item were collected, and the overall effect of clinical path management in 2015 to 2016 was analyzed by comparative analysis. The implementation of clinical pathway management in this hospital in 2016 was compared and the optimal clinical pathway was analyzed. Results: fifteen indexes to evaluate the implementation of clinical path management in traditional Chinese medicine hospital were determined, and an empirical study was carried out on a Chinese medicine hospital in Guangdong province. The results showed that, The average disease entry rate of clinical path management in the empirical hospital in 2016 was 60.39, which was significantly higher than the average of 51.20% in 2015, and the difference was statistically significant after independent sample T test (P0.05). The clinical pathway of atrial fibrillation in cardiovascular department was the highest in the rate of entry (positive index) after screening. The clinical pathway of colonic polyp in digestive department was the lowest in average drug cost (negative index) and the rank sum test (P0.05) was the lowest in each clinical pathway, and the difference was statistically significant. Conclusion: the results of this study show that the overall evaluation of clinical path management in empirical hospitals in 2016 is superior to that in 2015. The efficiency of the clinical pathway implementation process was improved, in which the disease entry rate and the path completion rate were improved, but the path completion rate was not high, and the path variation rate was higher and increased. Therefore, the early management and the later summary of clinical pathway implementation should be strengthened. Improve the executive ability of clinical pathway management. The effect of clinical path implementation has achieved good development, the average hospitalization days have been continuously reduced, the mortality rate has been controlled steadily, the clinical path curative effect has been more up to standard, but the readmission rate has increased slightly, so we should further standardize the diagnosis and treatment process and improve the quality of medical treatment. Chinese medicine has been widely used in clinical path management, but the cost of traditional Chinese medicine is not high, so we should further highlight the advantages of traditional Chinese medicine in the implementation of clinical pathway. Improve the social and economic benefits of traditional Chinese medicine. The cost of controlling medical consumables is good, but the average cost of medical treatment is rising, so we should further standardize the process of diagnosis and treatment, strengthen the monitoring of hospital expenses and drug expenses, and the information construction of clinical path is not perfect. It is still necessary to combine the clinical pathway with the electronic medical record effectively and focus on the systematic path management. In addition, the clinical pathway of atrial fibrillation was the highest in the clinical pathway management of empirical hospital in 2016, and the clinical pathway of colorectal polyp was the best to control the drug cost.
【學(xué)位授予單位】：廣州中醫(yī)藥大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類(lèi)號(hào)】：R197.4

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本文編號(hào)：2085878