医护人员实施临床路径的依从性评价——基于河南省医疗服务供方支付制度改革前后的比较

摘要

目的:通过对河南供方支付制度改革的实践调研,分析在支付改革背景下医护人员对临床路径依从性的变化.方法:将试点地区临床路径文本与国家和省级标准比对,调查医护人员对临床路径的认知,考察临床路径执行吻合度以评估其依从情况.结果:目前实施的临床路径样本已经在国家或省级标准下进行机构级别的细化；医护人员参与制定和细化的临床路径更能够得到医护人员的认同和依从；从实施情况来看,县级医院人员临床路径依从性情况要好于乡镇卫生院.结论:临床路径的实施态度,决定了依从情况,进而决定最终效果.临床路径的制定与开发既需要落实已有标准,更要让医护人员参与制定过程,以保证其对临床路径的依从.%Objective:In this paper,we evaluate the adherence change of implementation of clinical pathway (CP) in the context of payment reform.This evaluation is based on a survey of Henan provider payment reform.Method:We compare specific clinical pathways with national (provincial) standards,investigate medical staffs cognitive and judgment for CP,and use CP implementation relevance to examine the implementation.Result:We found that the current implementation of the clinical path samples have been taken at the national or provincial standards for agency-level refinement.Inviting medical staff to participate in the development and refinement of clinical path could ensure better acceptance and compliance among medical staffs.The implementation of clinical pathways of county level is better than that for township hospitals.Conclusion:Medical staffs' attitudes towards CP affects CP adherence and determines the output of provider's medical behavior.The development should be in line with government standards and requires the participation of medical staff.This can improve the CP adherence of medical profession.