慢性阻塞性肺疾病急性加重临床路径的实施及影响因素

doi:10.3969/j.issn.1006-7795.2023.01.006

首都医科大学学报 ›› 2023, Vol. 44 ›› Issue (1): 35-41.doi: 10.3969/j.issn.1006-7795.2023.01.006

• 临床流行病和临床试验 • 上一篇下一篇

慢性阻塞性肺疾病急性加重临床路径的实施及影响因素

王映权^1#, 冯琳^2#, 左颖婷², 童朝晖¹, 梁立荣^2*

1.首都医科大学附属北京朝阳医院呼吸与危重症医学科/北京市呼吸疾病研究所,北京 100020;
2.首都医科大学附属北京朝阳医院临床流行病学研究室/北京市呼吸疾病研究所,北京 100020

收稿日期:2022-10-24 出版日期:2023-02-21 发布日期:2023-01-13
作者简介:^#共同第一作者。
基金资助:
北京市属医院科研培育计划项目(PX2020014),北京市科技计划项目(Z201100005520028),北京市重大疫情防治重点专科项目。

Implementation and related influencing factors of the clinical pathway of acute exacerbation of chronic obstructive pulmonary disease

Wang Yingquan^1#, Feng Lin^2#, Zuo Yingting², Tong Zhaohui¹, Liang Lirong^2*

1. Department of Respiratory and Critical Care Medicine, Beijing Institute of Respiratory Medicine and Beijing Chaoyang Hospital, Capital Medical University, Beijing 100020, China;
2. Department of Clinical Epidemiology, Beijing Institute of Respiratory Medicine and Beijing Chaoyang Hospital, Capital Medical University, Beijing 100020, China

Received:2022-10-24 Online:2023-02-21 Published:2023-01-13
Contact: *E-mail:llrcruie@163.com
Supported by:
Beijing Municipal Administration of Hospitals Incubating Program(PX2020014),Science and Technology Program of Beijing (Z201100005520028), Beijing Key Specialists in Major Epidemic Prevention and Control.

摘要/Abstract

摘要： 目的分析慢性阻塞性肺疾病急性加重(acute exacerbation of chronic obstructive pulmonary disease, AECOPD)住院患者临床路径(clinical pathway, CP)在某三甲综合医院的实施情况与现存问题,提出相应的改进建议。方法通过北京某三甲综合医院大数据综合应用平台选取出2016年1月1日-2021年12月31日所有出院病案首页主要诊断为AECOPD的病例。分析该病种住院患者临床路径入径率及路径完成率,比较入径与未入径患者间、完成路径与未完成路径患者间临床特征及住院结局的差异,并采用多因素Logistic回归分别分析影响患者入径与完成的因素。结果共纳入1 817例病例,AECOPD住院患者临床路径的总入径率为20.7%,入径病例中路径总完成率为66.0%,不同年份间入径率存在差异,但路径完成率差异不显著。年龄、Charlson合并症指数≥2分是患者未入径的独立影响因素;合并呼吸衰竭及中重度肾病是患者未完成路径的独立影响因素。患者是否入径、是否完成路径与其住院病死率和住院时间无显著关联,但未完成路径患者的住院总费用更高。结论真实世界中,某三甲综合医院AECOPD临床路径的入径率、路径完成率均较低。特别是高龄、合并严重慢性疾病的AECOPD患者临床路径实施情况不佳,建议细化完善这类患者入径和转出标准,以提高临床路径的实施效果。

关键词: 慢性阻塞性肺疾病急性加重, 临床路径, 住院费用, 影响因素

Abstract: Objective To investigate the effect and implementation of clinical pathway(CP) for hospitalized patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD) in a tertiary general hospital, analyze the existing problems and propose corresponding suggestions. Methods Patients with primary diagnose of AECOPD were selected from January 1^st, 2016 to December 31^st, 2021 through the hospital's integrated big data platform. The clinical baseline characteristics, clinical outcomes, and hospitalization costs were compared with each other between those entered CP of AECOPD and those not, and the factors affecting the enter of CP were analyzed with multivariate Logistic regression. Similar analyses were done between those completed CP and those not completed CP implementation. Results A total of 1 817 hospitalized patients with AECOPD were included. Among these cases, 20.7% (377 of 1 817) of them entered CP of AECOPD, and the proportion changed significantly during the study period. Further, 66.0% (249 of 377) of those entered CP of AECOPD completed the CP, and the proportion did not change significantly during the study period. Age and Charlson Comorbidity Index (CCI) ≥ 2 were the independent influencing factors of not entering CP, and comorbidities of respiratory failure, moderate to severe renal disease were the independent influencing factors of not completing CP. Neither entering CP nor completing CP has significant correlation with patients' in-hospital mortality and length of stay. However, the patients who completed the CP had less medical costs than whose who didn't. Conclusion In real world, the proportion of AECOPD patients who entered CP and the proportion of those completed CP in a tertiary general hospital are both relatively low, especially among the elderly and those with severe chronic comorbidities. The entry and exit criteria of the clinical pathway for these patients should be detailed to improve the implementation of the AECOPD clinical pathway.

Key words: acute exacerbation of chronic obstructive pulmonary disease, clinical pathway, hospitalization costs, influencing factor

中图分类号:

王映权, 冯琳, 左颖婷, 童朝晖, 梁立荣. 慢性阻塞性肺疾病急性加重临床路径的实施及影响因素[J]. 首都医科大学学报, 2023, 44(1): 35-41.

Wang Yingquan, Feng Lin, Zuo Yingting, Tong Zhaohui, Liang Lirong. Implementation and related influencing factors of the clinical pathway of acute exacerbation of chronic obstructive pulmonary disease[J]. Journal of Capital Medical University, 2023, 44(1): 35-41.

参考文献

[1] Mannino D M, Buist A S. Global burden of COPD: risk factors, prevalence, and future trends[J]. Lancet, 2007, 370(9589): 765-773.
[2] Wang C, Xu J, Yang L, et al. Prevalence and risk factors of chronic obstructive pulmonary disease in China (the China Pulmonary Health [CPH] study): a national cross-sectional study[J]. Lancet, 2018,391(10131):1706-1717.
[3] Srivastava K, Thakur D, Sharma S, et al. Systematic review of economic burden in symptomatic chronic obstructive pulmonary disease (COPD) patients[J]. Value Health, 2014,17: A173－A174.
[4] Global Initiative for Chronic Obstructive Lung Disease. 2023 GOLD REPORT[EB/OL]. [2022-12-11]. https://goldcopd.org/2023-gold-report-2/.
[5] 赵鑫,王阶,陈光. 中医临床路径发展现状及对策研究 [J]. 中国医院管理,2019,39(2): 44-46.
[6] Jabbour M, Newton A S, Johnson D, et al. Defining barriers and enablers for clinical pathway implementation in complex clinical settings[J]. Implement Sci, 2018,13(1):139.
[7] Plishka C T, Rotter T, Penz E D, et al. Effects of clinical pathways for COPD on patient, professional, and systems outcomes: a systematic review[J]. Chest, 2019,156(5):864-877.
[8] 朱红霞,冯妍,孙晓雪.临床护理路径在慢性阻塞性肺疾病急性加重期护理中的临床应用 [J].检验医学与临床,2014,11(1):113-114.
[9] 孟伟娜,李丹,彭丽萍,等.慢性阻塞性肺疾病急性加重期患者治疗中实施临床路径的效果 [J].中国老年学杂志,2012,32(4):807-808.
[10] 国家卫生计生委办公厅. 国家卫生计生委办公厅关于实施有关病种临床路径的通知[EB/OL]。 [2022-06-09].http://www.nhc.gov.cn/yzygj/s7659/201612/e02b9324fc344f45979b6c20d7497b71.shtml
[11] 王斌,忻凌,陈迪,等.基于医院数据库的临床路径在脑梗死患者中的应用效果评价:一项真实世界研究 [J].世界科学技术-中医药现代化,2020,22(11):3972-3976.
[12] Taylor W J, Wong A, Siegert R J, et al. Effectiveness of a clinical pathway for acute stroke care in a district general hospital: an audit [J]. BMC Health Serv Res, 2006, 23(6): 16-23.
[13] 中华医学会呼吸病学分会慢性阻塞性肺疾病学组,中国医师协会呼吸医师分会慢性阻塞性肺疾病工作委员会.慢性阻塞性肺疾病诊治指南(2021年修订版) [J].中华结核和呼吸杂志,2021,44(3):170-205.
[14] 赵前前,李嘉琛,梁立荣.基于电子病历的呼吸专病医疗大数据综合应用平台数据质控体系构建及应用 [J].医学信息学杂志,2022,43(7):55-60.
[15] 陈永聪,白洁,魏雪峰,等.我国公立医院临床路径实施状况分析[J]. 中华医院管理杂志,2017,33(1):21-23.
[16] 赵亮,张颖,胡牧,等.临床路径实施与应用效果探讨 [J].中华医院管理杂志,2010(7):497-500.
[17] 丁爱萍.我国临床路径实施的现状与分析 [J].中医药管理杂志,2020,28(18):162-164.
[18] Christenson S A, Smith B M, Bafadhel M, et al. Chronic obstructive pulmonary disease[J]. Lancet, 2022, 399(10342):2227-2242.
[19] 孙雪松,高雪娟,张艳,等.医改背景下基于DRGs的临床路径实施效果评价 [J].现代医院管理,2022,20(5):31-35.
[20] Li J, Liang L, Cao S, et al. Secular trend and risk factors of 30-day COPD-related readmission in Beijing, China[J]. Sci Rep, 2022 12(1):16589.
[21] 田帝,周典,周苑,等.临床路径管理与DRG支付方式改革协同关系研究 [J].中国医院管理,2022,42(10):13-17.
[22] 陶红兵,刘鹏珍,梁婧,等.实施临床路径的医院概况及其成因分析 [J].中国医院管理,2010,30(2):28-30.
[23] 奚蓓蓓,吴昕霞,张晨,等. 临床路径管理与信息系统结合策略[J]. 中华医院管理杂志,2014,30(3):188-190.

慢性阻塞性肺疾病急性加重临床路径的实施及影响因素

Implementation and related influencing factors of the clinical pathway of acute exacerbation of chronic obstructive pulmonary disease

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