CAJ | 학술논문

目的：研究临床路径对某院高压氧科3病种住院次均费用及药占比的影响。方法回顾性分析实施临床路径前（2009.01.01-2011.12.31）与实施临床路径后（2012.01.01-2014.12.31）急性一氧化碳中毒411例、一氧化碳中毒迟发脑病766例、突发性聋335例的住院次均费用、药占比及平均住院日的不同。结果临床路径的实施有效降低了3病药占比（P＜0.01），急性一氧化碳中毒药占比由61%降至49%、一氧化碳中毒迟发脑病药占比由63%降至56%、突发性聋药占比由56%降至49%；降低了3病平均住院日（P＜0.01），急性一氧化碳中毒平均住院日由15.36天降至12.73天、一氧化碳中毒迟发脑病平均住院日15.97天降至13.93天、突发性聋平均住院日13.89天降至12.08天；并降低了一氧化碳中毒迟发脑病(9600元降至8800元)、突发性聋（9400元降至8700元）的次均费用（P＜0.01，P＜0.05）。结论临床路径管理可合理控制医疗费用，增加非药物性治疗比例，提高病床周转率，促进医院资源的有效利用，有助于深化医疗制度改革。
목적：연구림상로경대모원고압양과3병충주원차균비용급약점비적영향。방법회고성분석실시림상로경전（2009.01.01-2011.12.31）여실시림상로경후（2012.01.01-2014.12.31）급성일양화탄중독411례、일양화탄중독지발뇌병766례、돌발성롱335례적주원차균비용、약점비급평균주원일적불동。결과림상로경적실시유효강저료3병약점비（P＜0.01），급성일양화탄중독약점비유61%강지49%、일양화탄중독지발뇌병약점비유63%강지56%、돌발성롱약점비유56%강지49%；강저료3병평균주원일（P＜0.01），급성일양화탄중독평균주원일유15.36천강지12.73천、일양화탄중독지발뇌병평균주원일15.97천강지13.93천、돌발성롱평균주원일13.89천강지12.08천；병강저료일양화탄중독지발뇌병(9600원강지8800원)、돌발성롱（9400원강지8700원）적차균비용（P＜0.01，P＜0.05）。결론림상로경관리가합리공제의료비용，증가비약물성치료비례，제고병상주전솔，촉진의원자원적유효이용，유조우심화의료제도개혁。
Objective To investigate the application effect of clinical pathway on hospitalization expenses and proportion of drug of acute carbon monoxide poisoning(ACOP),delayed encephalopathy after ACOP and sudden deafness.Methods Through the retrospective survey and contrastive analysis the difference of hospitalization expenses,proportion of drug and average hospitalization days between before(2009.01.01-2011.12.31)and after (2012.01.01-2014.12.31) the implementation of clinical pathway on the upper three types of disease.Results Implementation of clinical pathways effectively reduced proportion of drug(P<0.01)on ACOP(61% decreased to 49%),delayed encephalopathy after ACOP(63% decreased to 56%) and sudden deafness(56% decreased to 49%),reduced average hospitalization days(P<0.01)on ACOP(15.36 days decreased to 12.73 days),delayed encephalopathy after ACOP(15.97 days decreased to 13.93 days) and sudden deafness(13.89 days decreased to 12.08 days),also reduced the hospitalization expenses on delayed encephalopathy after ACOP(9600 yuan decreased to 8800 yuan) and sudden deafness(9400 yuan decreased to 8700 yuan)(P<0.01,P<0.05) ConclusionsClinical pathways management can reasonably control medical expenses,increase the proportion of non drug treatment,improve the turnover rate of hospital beds,improve the effective utilization of hospital resources,and deepen the reform of medical system.