基于信息管理系统的急性心梗医疗质量改进分析
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摘要
目的开发JCI-CCPC团队照护与患者信息管理系统,探讨导入CCPC-AMI前后STEMI医疗质量的改进效果。方法运用回顾性对比分析法,选择导入后2017年1月-6月77例患者和导入前2015年1月-6月51例患者为实验组和对照组。以患者到达急诊科至首次心电图接诊时间、到达急诊科至确诊STEMI时间、到达急诊科至采血时间、门球时间、住院天数、均次费用、是否院内AMI复发、是否院内再次PCI和转归等为评价指标。结果与对照组比较,实验组在患者到达急诊科至首次心电图接诊时间、至采血时间、门球时间、住院天数、门球时间90分钟达标率、院内AMI复发率、院内再次PCI率和患者转归等方面均有统计学差异,均次费用、至确诊急性心肌梗死时间无统计学差异。结论基于信息管理系统的CCPC-AMI可显著缩短STEMI门球时间,住院时间、院内AMI复发率、院内再次PCI率和患者病死率均显著下降,但均次费用改善效果不显著。
Objective To develop JCI-CCPC team care and patient information management system,and to explore the improvement effect of STEMI medical quality before and after CCPC-AMI. Methods A retrospective comparative analysis method was used to select 77 patients from January to June 2017 as the experimental group,and 51 patients from January to June 2015 before the introduction as the control group.The evaluate indicators included time durationfrom the patient arriving in the emergency department to the first ECG,time durationfrom the arriving in the emergency department to the confirmation of the STEMI,time duration from the arriving in the emergency department to the blood collection,the door to balloon time,the length of stay,the average cost,whether the hospital has an AMI recurrence,whether the hospital has another PCI and the clinical outcome. Results Compared with the control group,the experimental group had statistical significantly difference on time duration from the patient arriving in the emergency department to the first ECG,to the confirmation of the STEMI,to the blood collection,the door to balloon time,the length of stay,the average cost,whether the hospital has an AMI recurrence,whether the hospital has another PCI and the patient mortality rate.However,there was no statistical difference on the average cost. Conclusion The CCPC-AMI based on the information management system can significantly shorten the STEMI door to balloon time.The hospitalization time,the inhospital AMI recurrence rate,the in-hospital PCI recurrence rate and the patient mortality rate were all significantly reduced,but the average cost improvement effect was not significant.
Objective To develop JCI-CCPC team care and patient information management system,and to explore the improvement effect of STEMI medical quality before and after CCPC-AMI. Methods A retrospective comparative analysis method was used to select 77 patients from January to June 2017 as the experimental group,and 51 patients from January to June 2015 before the introduction as the control group.The evaluate indicators included time durationfrom the patient arriving in the emergency department to the first ECG,time durationfrom the arriving in the emergency department to the confirmation of the STEMI,time duration from the arriving in the emergency department to the blood collection,the door to balloon time,the length of stay,the average cost,whether the hospital has an AMI recurrence,whether the hospital has another PCI and the clinical outcome. Results Compared with the control group,the experimental group had statistical significantly difference on time duration from the patient arriving in the emergency department to the first ECG,to the confirmation of the STEMI,to the blood collection,the door to balloon time,the length of stay,the average cost,whether the hospital has an AMI recurrence,whether the hospital has another PCI and the patient mortality rate.However,there was no statistical difference on the average cost. Conclusion The CCPC-AMI based on the information management system can significantly shorten the STEMI door to balloon time.The hospitalization time,the inhospital AMI recurrence rate,the in-hospital PCI recurrence rate and the patient mortality rate were all significantly reduced,but the average cost improvement effect was not significant.
引文
[1]Joint Commission International.JCI-Accredited Organizations:Huangshi Central Hospital JCI Accreditation[EB/OL].[2018-03-11].https://www.jointcommissioninternational.org/about-jci/jci-accredited-organizations/?c=China&pg=2.
[2]张杰,尹潘龙,范天恒,等.JCI-CCPC团队照护与病患信息管理系统[EB/OL].[2018-03-11].http://www.psssystem.gov.cn/sipopublicsearch/patentsearch/showViewList-jumpToView.shtml.
[3]Joint Commission International.JCI Survey Process Guide for Clinical Care Program Certification,3rd Edition,English version[EB/OL].[2018-03-11].https://www.jointcommissioninternational.org/jci-survey-process-guide-for-clinical-care-program-certification-3rd-edition-english-version-pdf-book-/.
[4]O'Gara PT,Kushner FG,Ascheim DD,et al.2013ACCF/AHA guideline for the management of ST-elevation myocardial infarction:a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines[J].J Am Coll Cardiol,2013,29(4):78-140.
[5]沈卫峰,张奇,张瑞岩.2015年急性ST段抬高型心肌梗死诊断和治疗指南解析[J].国际心血管病杂志,2015(4):217-219.
[6]健康界.第五届全国医院品管圈大赛榜单出炉[EB/OL].[2018-03-11].http://www.cn-healthcare.com/article/20170924/content-495924.html.
[7]健康界.2015中国患者安全大会:患者安全共同责任[EB/OL].[2018-03-11].http://www.cn-healthcare.com/article/20151219/content-480539.html.
[2]张杰,尹潘龙,范天恒,等.JCI-CCPC团队照护与病患信息管理系统[EB/OL].[2018-03-11].http://www.psssystem.gov.cn/sipopublicsearch/patentsearch/showViewList-jumpToView.shtml.
[3]Joint Commission International.JCI Survey Process Guide for Clinical Care Program Certification,3rd Edition,English version[EB/OL].[2018-03-11].https://www.jointcommissioninternational.org/jci-survey-process-guide-for-clinical-care-program-certification-3rd-edition-english-version-pdf-book-/.
[4]O'Gara PT,Kushner FG,Ascheim DD,et al.2013ACCF/AHA guideline for the management of ST-elevation myocardial infarction:a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines[J].J Am Coll Cardiol,2013,29(4):78-140.
[5]沈卫峰,张奇,张瑞岩.2015年急性ST段抬高型心肌梗死诊断和治疗指南解析[J].国际心血管病杂志,2015(4):217-219.
[6]健康界.第五届全国医院品管圈大赛榜单出炉[EB/OL].[2018-03-11].http://www.cn-healthcare.com/article/20170924/content-495924.html.
[7]健康界.2015中国患者安全大会:患者安全共同责任[EB/OL].[2018-03-11].http://www.cn-healthcare.com/article/20151219/content-480539.html.