临床路径质量评价体系构建及应用研究

摘要

目的 建立临床路径质量综合评价体系并进行评价验证.方法 采用文献检索、聚类合并及专家咨询方法确定临床路径质量评价指标,运用灰色关联方法计算评价指标的权重系数,对评价指标进行等级评分,综合评价指标加权评分,建立临床路径质量综合评价模型.选取2015年上海市18家三级甲等综合医院指标数据进行验证.结果 共选取入径率、变异率、完成率、平均住院日等12项评价指标,经权重计算和等级评分后,构建临床路径质量综合评价数学模型.将18家医院的数据代入评价体系进行赋值评分计算,得到每家医院的综合分值和排序,可发现下一年度重点管理医院和重点干预指标.结论 该临床路径评价体系将不同的医院放在同一个平台进行比较,其结果能够量化表达;提示卫生行政管理部门下一阶段应该重点管理的医院和重点管理的环节,使临床路径的前瞻性管理成为可能.%Objective To establish a comprehensive evaluation system for clinical pathway quality for evaluation and verification.Methods Literature retrieval, clustering mergers and experts consultation method were used to determine indicators for clinical pathway quality evaluation, while gray correlation method was employed to calculate indicators weight coefficient and to evaluate indicators scoring,and sum indicators weighted scoring, so as to establish a clinical pathway quality comprehensive evaluation model.Indicator data of Shanghai′s 18 tertiary hospitals were used for verification.Results A total of 12 evaluation indicators, such as entry rate, mutation rate, completion rate and average length of stay were selected.After the weight calculation and grade scoring, the mathematical model of clinical pathway quality comprehensive evaluation was constructed.Data of these hospitals were put into the evaluation system for assigning ratings calculation, harvesting the overall score and ranking of each hospital.These data can help find out key management and key hospital intervention indicators in the next stage.Conclusions Different hospitals will be put on the same platform for comparison in this clinical pathway evaluation system, and the results can be quantified.The authors suggest that the next stage of health administration focus on the management of the hospitals and the key management of the sectors, making possible the prospective management of clinical pathways.