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[摘要]
目的:探讨年龄相关性白内障临床路径与非临床路径患者在住院成本、手术效果等方面的差异,并行成本-效果分析。
方法:收集2014-09-01/2015-09-01于陕西省人民医院第一诊断为年龄相关性白内障或老年性白内障(ICD 10:H25.901)、并行白内障超声乳化摘除术和人工晶状体植入术(ICD 10:13.4102+13.701)的患者649例。其中,临床路径组为108例,非临床路径组为541例。用住院费用和误工费之和来衡量住院成本,用术后视力改变量来衡量效果,并进行成本-效果分析。
结果:临床路径组在床位费、诊查费、护理费、检查费、化验费、住院总费用等方面所需要的费用明显少于非路径组; 临床路径组的人均误工费明显少于非临床路径组; 临床路径组与非路径组之间的术后视力改变量并无统计学差异(P>0.05); 临床路径组的成本-效果比要低于非临床路径组,说明临床路径组的方案较优。
结论:临床路径的方案较优,在降低医疗费用的基础上并不会影响白内障手术术后的疗效; 临床路径通过控制平均住院日而降低了有关费用支出; 临床路径通过规范诊疗行为而降低了有关费用支出。
[Key word]
[Abstract]
AIM: To investigate the difference in hospitalization cost and operation results between the clinical path and non-clinical path of the age related cataract patient and carry out cost-result analysis.
METHODS:A total of 649 patients who were diagnosed initially as senile cataract or age-related cataract and received operations of parallel phacoemulsification and intraocular lens implantation were selected in Shaanxi Provincial People's Hospital within time period between Sep. 1st, 2014 and Sep. 1st, 2015. Among them, 108 patients were in the group of clinical path, and the rest 541 patients were in non-clinical group. This paper utilized the sum of hospitalization expenses and other costs to measure the total costs and used the amount of change in visual acuity to measure results and carried out the cost-result analysis.
RESULTS: The cost of clinical pathway group in bed charges, checkups, care, inspection fees, laboratory fees and the total costs of hospitalization required were significantly less than the non-path group. The charge for loss of working time of the pathway group was significantly less than the non-clinical pathway group. The difference of the amount of change in visual acuity between the clinical pathway group and non-path group was not statistically significant(P>0.05). The results of the clinical pathway group-effectiveness rate was lower than the non-clinical pathway group, which meant the statement of program in clinical pathway group was better.
CONCLUSION: The clinical pathways optimum scheme is better, which can reduce the medical costs without affecting the efficacy of postoperative cataract surgery. The clinical path group can reduce relevant costs through controlling the days of hospitalization. The clinical path group can reduce relevant costs through standardizing diagnosis and treatment behavior.
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