电子化临床护理路径的开发研究
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摘要
随着医疗卫生体制改革的逐步深入,医疗市场的竞争日趋激烈,医院只有进一步加强医疗质量管理、在维持或提高医疗服务质量的前提下降低住院费用、减少住院时间、节约卫生资源、提高医疗效益/成本比,才能为人民群众提供价廉、质优高效的医疗卫生服务,并且在激烈的医疗市场竞争中处于优势地位。
本文结合浙江大学医学院附属第一医院的数字卫生项目,介绍了电子化临床护理路径的设计和开发,并与医院现有护理电子病历系统及临床信息系统(CIS)整合应用。文中论证了临床护理路径在医院护理管理等方面的重要性,分析了国内外发展的状况,阐述了电子化临床护理路径的基本概念。重点是研究了临床护理路径的流程设计、管理模式、功能实现等内容。根据医院信息系统的发展趋势——面向医疗服务,在论述过程中,强调了以病人信息为中心。目的是通过研究,探索临床护理路径设计和应用的内在规律,寻找符合我国国情的临床护理路径实施办法。
With the deep reform of medical health care system and the progressively sharp competition of medical market, hospitals can provide people with medical health services with low-price, good quality and high efficiency and survive prominently in the competitive medical market by the enhancement of control of medical quality, decreases in hospitalization cost and hospitalization time, saving of hygiene resources, improvement of the ratio of medical efficiency to cost.
The design and development of the electronic clinical nursing pathway introduced in this thesis is based on the Digital Health topics of the first affiliated hospital, college of medicine, Zhejiang University. This system has been applied in combination with the Electronic Nursing Record system and present clinical information system(CIS) of the hospital. The text expounds and proves the importance of the electronic clinical nursing pathway management in hospital, analyzes the development at home and abroad, elaborates the basic concept of the electronic clinical nursing pathway. It is to examine the clinical care path process design, management, function realization and so on. According to the development trend of hospital information system-for medical services, in his discussion of the process, I emphasized the keystone of patient information. I studied this subject with purpose of the exploration of the internal laws of clinical pathway so as to find the practical and feasible methods for the practice of clinical pathway in China.
本文结合浙江大学医学院附属第一医院的数字卫生项目,介绍了电子化临床护理路径的设计和开发,并与医院现有护理电子病历系统及临床信息系统(CIS)整合应用。文中论证了临床护理路径在医院护理管理等方面的重要性,分析了国内外发展的状况,阐述了电子化临床护理路径的基本概念。重点是研究了临床护理路径的流程设计、管理模式、功能实现等内容。根据医院信息系统的发展趋势——面向医疗服务,在论述过程中,强调了以病人信息为中心。目的是通过研究,探索临床护理路径设计和应用的内在规律,寻找符合我国国情的临床护理路径实施办法。
With the deep reform of medical health care system and the progressively sharp competition of medical market, hospitals can provide people with medical health services with low-price, good quality and high efficiency and survive prominently in the competitive medical market by the enhancement of control of medical quality, decreases in hospitalization cost and hospitalization time, saving of hygiene resources, improvement of the ratio of medical efficiency to cost.
The design and development of the electronic clinical nursing pathway introduced in this thesis is based on the Digital Health topics of the first affiliated hospital, college of medicine, Zhejiang University. This system has been applied in combination with the Electronic Nursing Record system and present clinical information system(CIS) of the hospital. The text expounds and proves the importance of the electronic clinical nursing pathway management in hospital, analyzes the development at home and abroad, elaborates the basic concept of the electronic clinical nursing pathway. It is to examine the clinical care path process design, management, function realization and so on. According to the development trend of hospital information system-for medical services, in his discussion of the process, I emphasized the keystone of patient information. I studied this subject with purpose of the exploration of the internal laws of clinical pathway so as to find the practical and feasible methods for the practice of clinical pathway in China.
引文
[1]吴袁剑云,英立平.临床路径实施手册[M].北京：北京医科大学出版社,2002：122.
[2]陈伟菊.临床路径在新加坡樟宜综合医院的应用.实用护理杂志,2001,18(3)：141.
[3]Development and implementation of a clinical pathway for severe traumatic brain injury. Vitaz,-T-W; McIlvoy,-L; Raque,-G-H; Spain,-D; Shields,-C-B, J-Trauma.2001 Aug;51(2):369-75.
[4]Successful incorporation of the Severe Head Injury Guidelines into a phased-outcome clinical pathway. Mcilvoy,-L; Spain,-D-A; Raque,-G; Vitaz,-T; Boaz,-P; Meyer,-K, J-Neurosci-Nurs.2001 Apr; 33(2):72-8,82.
[5]Development and implementation of a clinical pathway for spinal cord injuries, Vitaz,-T-W; McIlvoy,-L; Raque,-G-H; Spain,-D-A; Shields,-C-B, J-Spinal-Disord.2001 Jun; 14(3):271-276.
[6]A clinical pathway for outpatient cancer pain management, Georgesen,-J, Oncology-(Huntingt),2000. Suppl Pt 1:13-6.
[7]The impact of a clinical pathway for gastric bypass surgery on resource utilization Cooney, Bryant,-P; Haluck,-R; Rodgers,-M; Lowery,-M, J-Surg-Res. 2001 Jun 15; 98(2):97-101.
[8]Mark Loeb Soo, Chan Carusone Ron Goeree. Effect of a Clinical Pathway to Reduce Hospitalizations in Nursing Home Residents With Pneumonia American Medical Association. All rights reserved:2503-2510.
[9]朱兰萍,马素红.临床护理路径在白内障手术中的应用.中国民康医学2008年3月第20期第6版：560-561.
[10]李萍,赖红梅,程薇.应用临床护理路径对骨科住院病人进行健康教育.中华护理杂志2001年11月第36卷第11期.
[11]杨晨霞,尹新.健康教育临床路径在斜视患儿护理中的应用.护理研究,2009年3月第23卷第3期中版总第280期：715-716
[12]孙川,石志成,王立等.临床路径在医疗改革新形势下的应用研究.当代医学,2009年1月15卷1期总第156期：1-3.
[13]郑西川,吴允真,夏新.支持临床路径过程的诊疗知识库处理设计分析.2009年第24卷第9期：18-19.
[14]Sacks HS. A nurse-led clinical pathway reduced hospitalizations in nursing home residents with pneumonia. ACP J Club.2006 Nov-Dec; 145(3):81.
[15]Loeb M, Carusone SC, Goeree R, et al. Effect of a clinical pathway to reduce hospitalizations in nursing home residents with pneumonia:a randomized controlled trial. JAMA.2006 Jun 7;295(21):2503-10.
[16]李艳明,刘玉锦,腔镜甲状腺大部切除术临床护理路径表的制作及应用.护士进修杂志,2009,11,990-991.
[17]Su WM, Huang JM. [The collaborative nursing care plan:integration of the clinical pathway with the traditional nursing care plan] Hu Li Za Zhi.2004 FEB;51(1):77-80.
[18]魏红蕾,冠状动脉搭桥术围手术期临床护理路径的编制、实施与评价.2008-10-6,硕士论文.
[19]Hao AT, Huang LF, Wu LB, et al. Building an innovation electronic nursing record pilot structure with nursing clinical pathway. Stud Health Technol Inform. 2006; 122:279-83.
[20]高峰.电子病历在临床信息系统中的应用.中山大学硕士学位论文,2008.
[21]陈伟菊.临床路径在新加坡樟宜综合医院的应用.实用护理杂志,2001,18(3)：141.
[22]余美珍.护理评估中常见的问题与对策.护理与康复,2004,3(4)：264-265.
[1]齐德广,秦银河,李书章,等.临床路径在医疗质量管理中的应用[J].中国医院管理,2002,22(10)：11.
[2]吴袁剑云,英立平.临床路径实施手册[M].北京：北京医科大学出版社,2002：122.
[3]鱼敏,关键路径法在美国医院中的应用[J].国外医学·医院管理分册,1996,13(2)：61-63.
[4]Kris Vanhaecht, Marcus Bollmann, Kathy Bower et al. Prevalence and use of clinical pathways in 23 countries:an international survey by the European Pathway Association. Journal of Integrated Care Pathways,2006,10:28-34.
[5]杨立群,薛继红,许俊艳,等.临床路径在日本的应用.国外医学护理学分册,2002,21(8)：373-374.
[6]Yueh B, Weaver EM, Bradley EH, et al. Acritical evaluation of critical pathways in head and neck cancer[J]. Arch Otolaryngol Head Neck Surg,2003,129(1):89.
[7]Okamura K, Ozawa H, Kinukawa T, et al. A questionnaire survey for TURP hospitalization by clinical path [J].Nippon Hinyokika Gakkai Zasshi,2004, 95(7):800.
[8]Brunenberg DE, vanSteyn MJ, Sluimer JC, et al. Joint recovery pro-gramme versus usual care:an economic evaluation of a clinical pathway for joint replacement surgery[J]. Med Care,2005,43(10):1018.
[9]张宏雁等.临床路径在医院管理中的应用.国外医学医院管理分册,2001,18(3)：98-101.
[10]Sacks HS. A nurse-led clinical pathway reduced hospitalizations in nursing home residents with pneumonia. ACP J Club.2006 Nov-Dec; 145(3):81.
[11]Carusone SC, Loeb M, Lohfeld L. A clinical pathway for treating pneumonia in the nursing home:part I:the nursing perspective. J Am Med Dir Assoc.2006 Jun; 7(5):271-278.
[12]Loeb M, Carusone SC, Goeree R, et al. Effect of a clinical pathway to reduce hospitalizations in nursing home residents with pneumonia:a randomized controlled trial. JAMA.2006 Jun 7;295(21):2503-10.
[13]王瑜(1),王秀珉(1),邹佩珍(2)等.临床护理记录电子模版的开发与应用.护理管理杂志,2007,7(7)：52-53.
[14]李艳明,刘玉锦,腔镜甲状腺大部切除术临床护理路径表的制作及应用,护士进修杂志,2009,11,990-991.
[15]魏红蕾.冠状动脉搭桥术围手术期临床护理路径的编制、实施与评价.复旦大学.硕士论文.2008
[16]成翼娟.医疗成本管理控制的好方法-临床路径[Z].肿瘤防治中心简报,2001-11-15.
[17]方立珍等,《临床路径-全新的临床服务模式》,湖南科学技术出版社.
[18]Mark Loeb Soo, Chan Carusone Ron Goeree. Effect of a Clinical Pathway to Reduce Hospitalizations in Nursing Home Residents With Pneumonia American Medical Association. All rights reserved:2503-2510.
[19]Schriefer J.1994. The Synergy of Pathways and Algorithms:Two Tools Work Better Than One. Journal of Quality Improvement. Vol.20(9):485-499.
[20]Nanly H, Chen BT, Lee LL, et al. A comparison of the quality of nursing care between pre- and postimplementing of a clinical pathway. J Clin Nurs.2005 Nov, 14(10):1260-1.
[21]Campbell H, Hotchkiss R, Bradshaw N, et al. Integrated care pathways. BMJ. 1998, Jan 10,316(7125):133-7.
[22]Dy SM, Garg P, Nyberg D et al. Critical pathway effectiveness:assessing the impact of patient, hospital care, and pathway characteristics using qualitative comparative analysis. Health Serv Res 2005; 40(2):499-516.
[23]朱兰萍,马素红.临床护理路径在白内障手术中的应用中国民康医学2008 年3月第20期第6版：560-561.
[24]李萍,赖红梅,程薇.应用临床护理路径对骨科住院病人进行健康教育中华护理杂志2001年11月第36卷第11期.
[25]杨晨霞,尹新.健康教育临床路径在斜视患儿护理中的应用护理研究2009年3月第23卷第3期中版总第280期：715-716
[26]孙川,石志成,王立等.临床路径在医疗改革新形势下的应用研究当代医学2009年1月15卷1期总第156期：1-3.
[27]Renholm M, Leino-Kilpi H, Suominen T. Critical pathways:a systematic review. Journal of Nursing Administration 2002; 32(4):196-202.
[28]Su WM, Huang JM. [The collaborative nursing care plan:integration of the clinical pathway with the traditional nursing care plan] Hu Li Za Zhi.2004 FEB;51(1):77-80.
[29]Hao AT, Huang LF, Wu LB, et al. Building an innovation electronic nursing record pilot structure with nursing clinical pathway. Stud Health Technol Inform. 2006;122:279-83.
[30]付玲玲,刘英华,牛艳华.临床护理路径管理软件的设计和应用.中国实用护理杂志,2006,22(12S)：57.
[31]郑西川,吴允真,夏新.支持临床路径过程的诊疗知识库处理设计分析2009年第24卷第9期：18-19.
[32]张帆,刘本禄.临床路径在我国医院管理中应用的现状与展望[J].中华医院管理杂志,2004,20(7)：410-413.
[33]余宝莲,武芳慧.实施临床路径的影响因素分析[J].护理研究,2004,18(12A)：2143.
[2]陈伟菊.临床路径在新加坡樟宜综合医院的应用.实用护理杂志,2001,18(3)：141.
[3]Development and implementation of a clinical pathway for severe traumatic brain injury. Vitaz,-T-W; McIlvoy,-L; Raque,-G-H; Spain,-D; Shields,-C-B, J-Trauma.2001 Aug;51(2):369-75.
[4]Successful incorporation of the Severe Head Injury Guidelines into a phased-outcome clinical pathway. Mcilvoy,-L; Spain,-D-A; Raque,-G; Vitaz,-T; Boaz,-P; Meyer,-K, J-Neurosci-Nurs.2001 Apr; 33(2):72-8,82.
[5]Development and implementation of a clinical pathway for spinal cord injuries, Vitaz,-T-W; McIlvoy,-L; Raque,-G-H; Spain,-D-A; Shields,-C-B, J-Spinal-Disord.2001 Jun; 14(3):271-276.
[6]A clinical pathway for outpatient cancer pain management, Georgesen,-J, Oncology-(Huntingt),2000. Suppl Pt 1:13-6.
[7]The impact of a clinical pathway for gastric bypass surgery on resource utilization Cooney, Bryant,-P; Haluck,-R; Rodgers,-M; Lowery,-M, J-Surg-Res. 2001 Jun 15; 98(2):97-101.
[8]Mark Loeb Soo, Chan Carusone Ron Goeree. Effect of a Clinical Pathway to Reduce Hospitalizations in Nursing Home Residents With Pneumonia American Medical Association. All rights reserved:2503-2510.
[9]朱兰萍,马素红.临床护理路径在白内障手术中的应用.中国民康医学2008年3月第20期第6版：560-561.
[10]李萍,赖红梅,程薇.应用临床护理路径对骨科住院病人进行健康教育.中华护理杂志2001年11月第36卷第11期.
[11]杨晨霞,尹新.健康教育临床路径在斜视患儿护理中的应用.护理研究,2009年3月第23卷第3期中版总第280期：715-716
[12]孙川,石志成,王立等.临床路径在医疗改革新形势下的应用研究.当代医学,2009年1月15卷1期总第156期：1-3.
[13]郑西川,吴允真,夏新.支持临床路径过程的诊疗知识库处理设计分析.2009年第24卷第9期：18-19.
[14]Sacks HS. A nurse-led clinical pathway reduced hospitalizations in nursing home residents with pneumonia. ACP J Club.2006 Nov-Dec; 145(3):81.
[15]Loeb M, Carusone SC, Goeree R, et al. Effect of a clinical pathway to reduce hospitalizations in nursing home residents with pneumonia:a randomized controlled trial. JAMA.2006 Jun 7;295(21):2503-10.
[16]李艳明,刘玉锦,腔镜甲状腺大部切除术临床护理路径表的制作及应用.护士进修杂志,2009,11,990-991.
[17]Su WM, Huang JM. [The collaborative nursing care plan:integration of the clinical pathway with the traditional nursing care plan] Hu Li Za Zhi.2004 FEB;51(1):77-80.
[18]魏红蕾,冠状动脉搭桥术围手术期临床护理路径的编制、实施与评价.2008-10-6,硕士论文.
[19]Hao AT, Huang LF, Wu LB, et al. Building an innovation electronic nursing record pilot structure with nursing clinical pathway. Stud Health Technol Inform. 2006; 122:279-83.
[20]高峰.电子病历在临床信息系统中的应用.中山大学硕士学位论文,2008.
[21]陈伟菊.临床路径在新加坡樟宜综合医院的应用.实用护理杂志,2001,18(3)：141.
[22]余美珍.护理评估中常见的问题与对策.护理与康复,2004,3(4)：264-265.
[1]齐德广,秦银河,李书章,等.临床路径在医疗质量管理中的应用[J].中国医院管理,2002,22(10)：11.
[2]吴袁剑云,英立平.临床路径实施手册[M].北京：北京医科大学出版社,2002：122.
[3]鱼敏,关键路径法在美国医院中的应用[J].国外医学·医院管理分册,1996,13(2)：61-63.
[4]Kris Vanhaecht, Marcus Bollmann, Kathy Bower et al. Prevalence and use of clinical pathways in 23 countries:an international survey by the European Pathway Association. Journal of Integrated Care Pathways,2006,10:28-34.
[5]杨立群,薛继红,许俊艳,等.临床路径在日本的应用.国外医学护理学分册,2002,21(8)：373-374.
[6]Yueh B, Weaver EM, Bradley EH, et al. Acritical evaluation of critical pathways in head and neck cancer[J]. Arch Otolaryngol Head Neck Surg,2003,129(1):89.
[7]Okamura K, Ozawa H, Kinukawa T, et al. A questionnaire survey for TURP hospitalization by clinical path [J].Nippon Hinyokika Gakkai Zasshi,2004, 95(7):800.
[8]Brunenberg DE, vanSteyn MJ, Sluimer JC, et al. Joint recovery pro-gramme versus usual care:an economic evaluation of a clinical pathway for joint replacement surgery[J]. Med Care,2005,43(10):1018.
[9]张宏雁等.临床路径在医院管理中的应用.国外医学医院管理分册,2001,18(3)：98-101.
[10]Sacks HS. A nurse-led clinical pathway reduced hospitalizations in nursing home residents with pneumonia. ACP J Club.2006 Nov-Dec; 145(3):81.
[11]Carusone SC, Loeb M, Lohfeld L. A clinical pathway for treating pneumonia in the nursing home:part I:the nursing perspective. J Am Med Dir Assoc.2006 Jun; 7(5):271-278.
[12]Loeb M, Carusone SC, Goeree R, et al. Effect of a clinical pathway to reduce hospitalizations in nursing home residents with pneumonia:a randomized controlled trial. JAMA.2006 Jun 7;295(21):2503-10.
[13]王瑜(1),王秀珉(1),邹佩珍(2)等.临床护理记录电子模版的开发与应用.护理管理杂志,2007,7(7)：52-53.
[14]李艳明,刘玉锦,腔镜甲状腺大部切除术临床护理路径表的制作及应用,护士进修杂志,2009,11,990-991.
[15]魏红蕾.冠状动脉搭桥术围手术期临床护理路径的编制、实施与评价.复旦大学.硕士论文.2008
[16]成翼娟.医疗成本管理控制的好方法-临床路径[Z].肿瘤防治中心简报,2001-11-15.
[17]方立珍等,《临床路径-全新的临床服务模式》,湖南科学技术出版社.
[18]Mark Loeb Soo, Chan Carusone Ron Goeree. Effect of a Clinical Pathway to Reduce Hospitalizations in Nursing Home Residents With Pneumonia American Medical Association. All rights reserved:2503-2510.
[19]Schriefer J.1994. The Synergy of Pathways and Algorithms:Two Tools Work Better Than One. Journal of Quality Improvement. Vol.20(9):485-499.
[20]Nanly H, Chen BT, Lee LL, et al. A comparison of the quality of nursing care between pre- and postimplementing of a clinical pathway. J Clin Nurs.2005 Nov, 14(10):1260-1.
[21]Campbell H, Hotchkiss R, Bradshaw N, et al. Integrated care pathways. BMJ. 1998, Jan 10,316(7125):133-7.
[22]Dy SM, Garg P, Nyberg D et al. Critical pathway effectiveness:assessing the impact of patient, hospital care, and pathway characteristics using qualitative comparative analysis. Health Serv Res 2005; 40(2):499-516.
[23]朱兰萍,马素红.临床护理路径在白内障手术中的应用中国民康医学2008 年3月第20期第6版：560-561.
[24]李萍,赖红梅,程薇.应用临床护理路径对骨科住院病人进行健康教育中华护理杂志2001年11月第36卷第11期.
[25]杨晨霞,尹新.健康教育临床路径在斜视患儿护理中的应用护理研究2009年3月第23卷第3期中版总第280期：715-716
[26]孙川,石志成,王立等.临床路径在医疗改革新形势下的应用研究当代医学2009年1月15卷1期总第156期：1-3.
[27]Renholm M, Leino-Kilpi H, Suominen T. Critical pathways:a systematic review. Journal of Nursing Administration 2002; 32(4):196-202.
[28]Su WM, Huang JM. [The collaborative nursing care plan:integration of the clinical pathway with the traditional nursing care plan] Hu Li Za Zhi.2004 FEB;51(1):77-80.
[29]Hao AT, Huang LF, Wu LB, et al. Building an innovation electronic nursing record pilot structure with nursing clinical pathway. Stud Health Technol Inform. 2006;122:279-83.
[30]付玲玲,刘英华,牛艳华.临床护理路径管理软件的设计和应用.中国实用护理杂志,2006,22(12S)：57.
[31]郑西川,吴允真,夏新.支持临床路径过程的诊疗知识库处理设计分析2009年第24卷第9期：18-19.
[32]张帆,刘本禄.临床路径在我国医院管理中应用的现状与展望[J].中华医院管理杂志,2004,20(7)：410-413.
[33]余宝莲,武芳慧.实施临床路径的影响因素分析[J].护理研究,2004,18(12A)：2143.