外科個案實施臨床路徑之成效探討

CNU IR > College of Smart Living > Dept. of Hospital and Health (including master's program) > Dissertations and Theses > Item 310902800/26541

Please use this identifier to cite or link to this item: https://ir.cnu.edu.tw/handle/310902800/26541

Title:	外科個案實施臨床路徑之成效探討 Effectiveness of Clinical Pathways: Effectiveness of Clinical Pathways:A Surgical cases stuty
Authors:	鄭麗芳
Contributors:	醫務管理系(所) 楊美雪
Keywords:	再入院醫療費用住院天數臨床路徑 readmission costs length of stay clinical pathways
Date:	2012
Issue Date:	2013-04-22 14:58:53 (UTC+8)
Abstract:	目的：某區域醫院發展臨床路徑，期能提高醫療效率降低醫療費用並維持醫療品質，然其經濟效益尚未被清楚地研究。本研究旨在探討該院外科病患實施臨床路徑後之住院天數、醫療費用與非計劃性再入院的影響。方法：本研究為經該院人體試驗委員會審查通過的回溯性次級資料之研究。選取該院申報資料庫之2006年與2007年進行單純性闌尾切除術、腹腔鏡膽囊切除術、乳房切除術、疝氣修補術與痔瘡切除術等案件，共1,165件為研究對象，臨床路徑實施前有568件；實施後有597件。以獨立樣本t檢定與卡方檢定進行臨床路徑實施前後兩組個案之住院天數、醫療費用與非計劃性再入院等之比較分析。結果：臨床路徑實施後，腹腔鏡膽囊切除術與痔瘡切除術個案之住院天數分別顯著些微少於實施前0.4天（p<0.001）與0.2天（p<0.05），其他切除術的個案之住院天數則未呈現顯著地減少。在醫療費用分析結果顯示，藥費有顯著地減少，平均每件減少之藥費，單純性闌尾切除術（820點, p<0.001）；乳房切除術（630點, p<0.05）；疝氣修補術（93點, p<0.001）；痔瘡切除術（55點, p<0.001），惟有腹腔鏡膽囊切除術個案臨床路徑實施後藥費沒有顯著地減少。單純性闌尾切除術與痔瘡切除術臨床路徑實施後個案，平均每件檢查費分別顯著地減少953點（p<0.001）與336點（p<0.001）。單純性闌尾切除術個案、疝氣修補術個案與痔瘡切除術個案之平均總住院費用於臨床路徑實施後皆顯著地減少，然而腹腔鏡膽囊切除術個案卻反而顯著地增加2,432點（p<0.001）。臨床路徑實施後個案，出院後十四日內非計劃性再入院與出院後三日內入急診皆無顯著地改變。結論：臨床路徑實施後減少醫療費用可能與藥費與檢查費減少有關，病患非計劃性再入院之情形未受到醫療費用減少的影響。本研究在臨床路徑之住院天數改善上，並未充份反應具說服力的實質改善證據。 Objectives: Although clinical pathways (CPs) have been introduced in a regional hospital, with the expectation of streamlining patient care delivery and maximize efficiency while minimizing cost without compromising outcome, their economical effectiveness is not well defined. The aim of this study was to investigate the effect of clinical pathways for surgical cases on length of hospital stay (LOS), cost and readmissions. Methods: This was an IRB-approved retrospective study on a hospital claims database. From 2006 to 2007, this study identified 1,165 cases undergoing appendectomy, laparoscopic cholecystectomy, mastectomy, inguinal herniorrhaphy and hemorrhoidectomy before (n = 568) and after (n = 597) introduction of a clinical pathway. Length of stay, cost per case, and unplanned readmissions were compared between the 2 groups using independent t-test and chi-square test. Results: Mean total length of stay among laparoscopic cholecystectomy and hemorrhoidectomy cases were slightly less in the postclinical pathway cases, average LOS decreases were 0.4 days (p<0.001) and 0.2 days (p<0.05) respectively, there were no significant decreases in length of stay in the other pre specified pathways cases. The analysis of the costs compared with postclinical pathway groups revealed that pharmacy costs for each of the considered surgical CPs showed a significant decrease, the only non-significant difference observed was in pathway for laparoscopic cholecystectomy cases, average reductions in cost related to pharmacy were found in appendectomy (820 RVUs, p<0.001); mastectomy (630 RVUs, p<0.05); inguinal herniorrhaphy (92 RVUs, p<0.001); hemorrhoidectomy (55 RVUs, p<0.001). The study also found that diagnostic and laboratory costs per case were significantly lower in pathway cases undergoing appendectomy (953 RVUs, p<0.001) and hemorrhoidectomy (336 RVUs, p<0.001). The average total hospital costs per case were significant decreases for pathways in the appendectomy, inguinal herniorrhaphy and hemorrhoidectomy, whereas there were significant increases in pathway for laparoscopic cholecystectomy cases (2,432 RVUs, p<0.001). After the pathways implementation, there was no significant change in either unplanned readmission within 14 days or emergency readmission within 3 days. Conclusions: These results demonstrate that potential cost savings of clinical pathways are associated with reduced pharmacy and diagnostic and laboratory costs without affecting unplanned readmissions for surgical cases, there is no convincing evidence to support the pathway improving in length of stay with regard to the considered CPs in this study.
Relation:	校內外均一年後公開，學年度：100，82頁
Appears in Collections:	[Dept. of Hospital and Health (including master's program)] Dissertations and Theses

Files in This Item:

File	Description	Size	Format
etd-0828112-222359.pdf		1740Kb	Adobe PDF	1820	View/Open
index.html		0Kb	HTML	1746	View/Open

Loading...