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目的比较近五年实施临床路径前后北京医院子宫肌瘤住院医疗情况及其费用变化,分析对医疗处置与费用构成比例的影响。方法回顾性分析2008年-2012年五年间我院子宫肌瘤符合临床路径入选的1356份病案,比较其住院诊治情况与费用信息,按实施临床路径前后进行资料对比分析,观察年度住院情况的变化,用SPSS16.0软件比较其统计学差异。结果近五年子宫肌瘤行子宫切除术患者的逐年平均住院日、人均护理费都有显著下降(P<0.01),人均总住院费、人均药费、检查治疗费都保持基本平稳(P>0.05);实施临床路径后子宫肌瘤总住院费用略有降低,平均住院日明显缩短,其差异都具有显著性(P>0.05),药费与检查治疗费用基本平稳(P>0.05)。进入路径626例,变异出路径93例,变异率为14.9%。结论临床路径可有效遏制了药费与检查治疗费用的不合理增长,降低平均住院日,有利于合理利用医疗资源,是确实有效的医疗改革措施。
Objective To compare the changes of hospitalization and expense of myomectomy in Beijing Hospital before and after the implementation of clinical pathology in the recent five years and analyze the influence on the proportions of medical treatment and expenses. Methods A retrospective analysis of 1356 cases of uterine fibroids in our hospital during the five years between 2008 and 2012 in line with the clinical pathology was conducted to compare the information of their hospitalization and treatment with the cost information and to compare the data before and after the implementation of clinical pathways and to observe the changes of annual hospitalization , Using SPSS16.0 software to compare the statistical differences. Results In the past five years, the annual average length of hospital stay and per capita nursing costs of hysterectomy patients with uterine fibroids were significantly decreased (P <0.01), the average per capita hospitalization expenses, per capita medical expenses and examination and treatment costs remained basically stable (P> 0.05). After the clinical pathway was implemented, the total cost of hospitalization for uterine fibroids decreased slightly and the average length of stay was significantly shortened. The difference was significant (P> 0.05). The cost of medication and examination and treatment were basically stable (P> 0.05). 626 cases were entered, 93 cases were changed and the mutation rate was 14.9%. Conclusion The clinical pathway can effectively curb the unhealthy growth of drug costs and examination and treatment costs, reduce the average length of stay, and help rational utilization of medical resources, which is indeed a valid medical reform measure.