Objective To analyze the role of Clinical Pathway in controlling hospitalization cost and to provide the basis for reasonable control of medical cost.Methods The data of patients undergoing unilateral and bilateral total hip replacement in 2005 and 2010 in Arthritis Clinical and Research Center of Peking University People's Hospital were retrospectively analyzed.There were 70 unilateral and 14 bilateral total hip replacement cases in 2005,whereas the number of those in 2010 was 173 and 46 respectively.All charges were assigned to 1 of 9 categories:hospital room,nursing,radiology and laboratory,prosthesis,blood transfusion,surgery,pharmacy,treatment,diagnosis.We compared the total costs and cost of each category between 2005 and 2010.Results There was no statistical significant difference between 2005 and 2010 in terms of age,gender distribution,pri mary disease and type of prosthesis.The total costs for unilateral and bilatcral total hip replacement was 40 852.72 yuan and 73 020.28 yuan in 2010,respectively.They were both significantly lower than those of 2005 (49 371.35 yuan and 80 962.61 yuan respectively).The charge for each category of total hip replacement in 2010 was 585.88,145.38,2 885.47,3 222.32,1 776.15,3 805.29,132.79,4 100.88,and 3 0953.75 yuan.Compared with 2005,each category of charge dropped in 2010,especially the cost of surgery,treatment,diagnosis and hospital room,which decreased by 35.11％,31.76％,31.40％ and 30.67％ respectively.The tendency of each category change in charge of unilateral and bilateral total hip replacement was similar to the overall costs.Conclusion The total costs for total hip replacement (unilateral and bilateral total hip replacement) in 2010 were lower than those of 2005,which might be the result of adopting Clinical Pathway since 2010.Nevertheless,the prosthesis cost accounted for a large proportion in both years.Therefore,controlling the prosthesis cost might be an effective way to reduce medical costs for total hip replacement.%目的 探讨临床路径管理对控制住院费用的作用,为合理控制医疗费用提供依据.方法 对2005年和2010年在北京大学人民医院骨关节中心接受全髋关节置换术患者的住院费用进行回顾性分析.2005年和2010年分别有84例患者和219例患者纳入研究.2005年单侧全髋关节置换和双侧全髋关节同时置换分别为70例、14例,2010年单侧全髋关节置换和双侧全髋关节同时置换分别为173例、46例.总住院费用包括床位费、护理费、化验检查费、假体耗材费、输血费、手术费、药品费、治疗费、诊疗费共9项,比较2005年与2010年总住院费用及各项住院费用.结果 2005年单侧全髋和双侧全髋关节同时置换病例的年龄、性别与2010年比较差异无统计学意义,2005年与2010年病例原发疾病种类及使用假体类型的差异无统计学意义.2010年单侧全髋关节置换术总住院费用为40 852.72元,双侧全髋关节同时置换术为73 020.28元,总住院费用较2005年(分别为49 371.35、80 962.61元)下降,差异有统计学意义.2010年全髋关节同时置换术各项住院费用分别为585.88、145.38、2 885.47、3 222.32、1 776.15、3 805.29、132.79、4 100.88、30 953.75元,较2005年下降,差异有统计学意义.其中手术费、治疗费、诊疗费和床位费下降最为明显,分别下降了35.11％、31.76％、31.40％和30.67％.单侧全髋与双侧全髋关节同时置换病例各项费用的变化趋势与总体费用相似.结论 2010年全髋关节置换术总住院费用较2005年降低,可能主要与科室从2010年起施行临床路径管理有关.在各项住院费用中,假体耗材费所占比例最大,控制假体耗材费是降低全髋关节置换术住院费用的有效手段.
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