临床路径在人工耳蜗植入手术治疗中的实施效果及评价
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摘要
目的评价临床路径管理对开展人工耳蜗植入术的实施效果。方法纳入我院耳鼻咽喉头颈外科2014年4月至2015年6月间入院诊治的253例双耳极重度感音神经性聋患者为临床路径组(按临床路径进行诊治,该临床路径是基于循证医学证据并结合我科的诊疗经验制订),并选取2013年1月至2014年3月间住院治疗的路径实施前入院诊治的234例双耳极重度感音神经性耳聋患者为非临床路径组,两组患者均实施了人工耳蜗植入术。比较两组患者的手术并发症发生率(植入体周围血肿的发生率)、住院时间、住院费用。结果两组患者基本资料的差异无统计学意义(P> 0.05),具有可比性。临床路径组较非临床路径组患者住院时间缩短(7.5 d vs. 6.7 d,P <0.000 1),住院费用减少(12 373元vs. 11 738元,P <0.000 1),术后植入体周围血肿发生率降低。结论临床路径管理进行诊治能够提高人工耳蜗植入术的安全性,能够有效降低人工耳蜗植入术的并发症发生率,并缩短手术患者住院时间,减少住院费用,确保人工耳蜗手术的高效性。
Objective To evaluate the application effect of clinical pathway management on cochlear implant surgery. Methods A total of 253 patients with profound sensorineural hearing loss who were admitted to the otolaryngology head and neck surgery department of our hospital from April 2004 to June 2015 were included in a clinical path group(the treatment was performed via clinical pathway which was formulated drawing on evidencebased medicine in conjunction with the clinical practice of our department). Moreover,234 patients with profound sensorineural hearing loss who were admitted to the hospital before the implementation of a clinical pathway from January 2013 to March 2014 were selected as a non-clinical pathway group,and both groups of patients were treated with cochlear implants. The incidences of surgical complications(incidences of peri-implant hematoma),length of hospital stays and hospitalization costs were compared within the two groups. Results There was no statistical significance concerning the difference in basic data between the two groups(P > 0.05),suggesting comparability.Compared to the non-clinical pathway group,the clinical pathway group showed shorter hospitalization time(7.5 d vs. 6.7 d,P < 0.001),less hospitalization costs(12 373 yuan vs. 11 738 yuan,P < 0.001),and reduced incidences of peri-implant hematoma. Conclusions Clinical path management can improve the safety of cochlear implant surgery,effectively reduce the incidences of cochlear implant complications,shorten the length of hospital stays,reduce hospitalization costs and ensure the efficiency of cochlear surgery.
Objective To evaluate the application effect of clinical pathway management on cochlear implant surgery. Methods A total of 253 patients with profound sensorineural hearing loss who were admitted to the otolaryngology head and neck surgery department of our hospital from April 2004 to June 2015 were included in a clinical path group(the treatment was performed via clinical pathway which was formulated drawing on evidencebased medicine in conjunction with the clinical practice of our department). Moreover,234 patients with profound sensorineural hearing loss who were admitted to the hospital before the implementation of a clinical pathway from January 2013 to March 2014 were selected as a non-clinical pathway group,and both groups of patients were treated with cochlear implants. The incidences of surgical complications(incidences of peri-implant hematoma),length of hospital stays and hospitalization costs were compared within the two groups. Results There was no statistical significance concerning the difference in basic data between the two groups(P > 0.05),suggesting comparability.Compared to the non-clinical pathway group,the clinical pathway group showed shorter hospitalization time(7.5 d vs. 6.7 d,P < 0.001),less hospitalization costs(12 373 yuan vs. 11 738 yuan,P < 0.001),and reduced incidences of peri-implant hematoma. Conclusions Clinical path management can improve the safety of cochlear implant surgery,effectively reduce the incidences of cochlear implant complications,shorten the length of hospital stays,reduce hospitalization costs and ensure the efficiency of cochlear surgery.
引文
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[11]SCHULD J,SCHAFER T,NICKEL S,et al.Impact of IT supported clinical pathways on medical staff satisfaction.A prospective longitudinal cohort study[J].Int J Med Inform,2011,80(3):151-156.
[12]徐崇娟,曹艳,李秀娟.单病种质量管理下胃癌根治术病人的健康教育路径[J].中国实用医药,2012,7(13):191-192.
[13]陈志丹,陈德杰.临床路径管理在结节性甲状腺肿住院病人中的应用[J].现代肿瘤医学,2016,24(3):380-381.
[14]郭琳,鲍晨辉,陈鑫莹,等.临床路径在进展期胃癌手术治疗中的实施效果与评价[J].腹部外科,2017,30(4):273-277.
[2]赵鲁平,李友伟,谭鸿,等.推进临床路径试点工作的早期管理经验[J].中国医院管理,2011,31(6):23-24.
[3]张宏雁,董军,秦银河,等.临床路径制定与住院诊疗质量实时控制中的应用[J].中华医院管理杂志,2002,18(6):336-338.
[4]马莹,刘艳军,余文兴.耳鼻喉专科临床路径管理应用效果评价与分析[J].河北医科大学学报,2015,36(1):30-33.
[5]马国胜,蔡曦光,孟永洁,等.23个病种实施临床路径效果分析[J].中华医院管理杂志,2013,29(5):353-356.
[6]BITNER G M.Hereditary deafness and phenotyping in humans[J].Br Med Bull,2002,63(1):73-94.
[7]戴朴.遗传性耳聋的预防和阻断[J].中华医师杂志,2007,87(40):2811-2813.
[8]韩德民,徐立,李永新,等.人工耳蜗[M].北京:人民卫生出社,2003:219-226.
[9]中华耳鼻咽喉头颈外科杂志编辑委员会,中华医学会耳鼻咽喉头颈外科学分会,中国残疾人康复协会听力语言康复专业委员会.人工耳蜗植入工作指南(2013)[J].中华耳鼻咽喉头颈外科杂志,2014,49(2):1-7.
[10]HUANG Z,LU X,DUAN H.On mining clinical pathway patterns from medical behaviors[J].Artif Intell Med,2012,56(1):35-50.
[11]SCHULD J,SCHAFER T,NICKEL S,et al.Impact of IT supported clinical pathways on medical staff satisfaction.A prospective longitudinal cohort study[J].Int J Med Inform,2011,80(3):151-156.
[12]徐崇娟,曹艳,李秀娟.单病种质量管理下胃癌根治术病人的健康教育路径[J].中国实用医药,2012,7(13):191-192.
[13]陈志丹,陈德杰.临床路径管理在结节性甲状腺肿住院病人中的应用[J].现代肿瘤医学,2016,24(3):380-381.
[14]郭琳,鲍晨辉,陈鑫莹,等.临床路径在进展期胃癌手术治疗中的实施效果与评价[J].腹部外科,2017,30(4):273-277.