CAJ | 학술논문

目的：探讨临床路径管理实施过程中的障碍原因及处置对策。方法回顾性分析医院2013年8－12月进入临床路径管理的282例患者（病种为胆囊结石腹腔镜胆囊切除术、慢性鼻－鼻窦炎、2型糖尿病）的完整临床资料，按照是否顺利完成临床路径管理分为两组，观察组140例均顺利完成临床路径，对照组142例未顺利完成临床路径，统计分析临床路径实施障碍原因，总结处置对策。结果观察组患者年龄显著小于对照组，文化程度显著优于对照组，自费者显著高于对照组，2型糖尿病患者病程显著短于对照组，差异均具有统计学意义（均P＜0．05）；多因素分析显示，年龄大、文化程度低、医保就医及2型糖尿病病程长是临床路径管理实施障碍的原因，差异均具有统计学意义（均P＜0．05）。结论针对年龄大、文化程度低、医保就医及2型糖尿病病程长等临床路径实施障碍原因，可加强健康教育、心理干预及康复指导，保证临床路径顺利实施。
목적：탐토림상로경관리실시과정중적장애원인급처치대책。방법회고성분석의원2013년8－12월진입림상로경관리적282례환자（병충위담낭결석복강경담낭절제술、만성비－비두염、2형당뇨병）적완정림상자료，안조시부순리완성림상로경관리분위량조，관찰조140례균순리완성림상로경，대조조142례미순리완성림상로경，통계분석림상로경실시장애원인，총결처치대책。결과관찰조환자년령현저소우대조조，문화정도현저우우대조조，자비자현저고우대조조，2형당뇨병환자병정현저단우대조조，차이균구유통계학의의（균P＜0．05）；다인소분석현시，년령대、문화정도저、의보취의급2형당뇨병병정장시림상로경관리실시장애적원인，차이균구유통계학의의（균P＜0．05）。결론침대년령대、문화정도저、의보취의급2형당뇨병병정장등림상로경실시장애원인，가가강건강교육、심리간예급강복지도，보증림상로경순리실시。
Objective To investigate the causes and countermeasures of obstacles in the process of implementation of clinical pathway management .Methods Retrospectively analyzed the complete clinical data of 282 cases of clinical pathway management ( disease patients with laparoscopic cholecystectomy for cholecystolithiasis , chronic rhinosinusitis , type 2 diabetes ) of in our hospital from August to December in 2013, according to whether the smooth completion of clinical pathway management was divided into two groups, 140 cases in observation group were successfully completed the clinical pathway , 142 cases in control group were not success-fully completed, counted and analyzed the causes of implementation of clinical pathway , summarried the disposal countermeasures .Re-sults Patients in observation group were significantly lower than that of control group in age , culture level was significantly better than control group , at their own expense was significantly higher than that in control group , patients with type 2 diabetes mellitus was signifi-cantly shorter than that of control group (P<0.05).The multivariate analysis showed that age , culture degree low, health care medi-cal and causes of disease type 2 diabetes were barriers in the process of implementation of clinical pathway management (P<0.05). Conclusion Age, low educational level, health care, medical treatment and the long duration of type 2 diabetes mellitus are obstacles of implementing clinical pathway , can strengthen the health education , psychological intervention and rehabilitation guidance , ensure the smooth implementation of clinical path .