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目的探讨高血压患者双向转诊临床路径,分析高血压患者双向转诊临床路径的效果。方法 2010-03-01—2011-09-30被瑞康医院承办的社区卫生服务中心转诊到瑞康医院心内科门诊和病房的高血压患者以及被瑞康医院心内科和病房转诊到瑞康医院所承办的社区卫生服务中心的高血压患者60例为试验组,另选取同时期自发到瑞康医院内科门诊、急诊和病房就诊的高血压患者60例为对照组。采用病例查阅、专家咨询、现场考察、试点研究、个人访谈等方法,建立高血压患者双向转诊临床路径。对比两组患者再次就诊率、首次就诊时间、住院时间、医疗费用(总费用、检查费、诊疗费、药费)以及患者的满意度。结果试验组高血压患者再次就诊率较对照组明显降低,差异有统计学意义(P<0.01)。试验组高血压患者首次就诊时间较对照组明显缩短,差异有统计学意义(P<0.05);两组住院时间比较,差异无统计学意义(P>0.05)。试验组高血压患者住院总费用、检查费、诊疗费、药费较对照组均明显降低,差异有统计学意义(P<0.05)。试验组高血压患者对医护人员服务态度的满意度、诊疗技术的满意度、对转诊疗效的满意度、对医疗费用的满意度较对照组均明显升高,差异有统计学意义(P<0.05)。结论双向转诊临床路径对高血压患者再次就诊率、首次就诊时间、住院时间、医疗费用以及患者的满意度均有影响,有很好的社会效果和经济效益,是切实可行有效的临床路径。
Objective To investigate the clinical pathway of bidirectional referral in hypertensive patients and analyze the clinical effect of bidirectional referral in hypertensive patients. Methods 2010-03-01-2011-09-30 Community health service center contracted by Ruikang Hospital Refer to hypertension patients in cardiology department and ward of Ruikang hospital and refer to Ruikang hospital cardiology department and ward 60 patients with hypertension in community health service centers contracted by Kang Hospital were selected as the experimental group. Another 60 hypertensive patients who were admitted to Ruikang Hospital during the same period spontaneously to medical clinic, emergency department and ward were selected as the control group. Case review, expert advice, field visits, pilot studies, personal interviews and other methods to establish two-way referral clinical pathways of hypertensive patients. Patients in two groups were compared again, the first visit time, hospital stay, medical expenses (total cost, examination fee, medical expenses, medical expenses) and patient satisfaction. Results The re-visit rate of hypertensive patients in the experimental group was significantly lower than that of the control group (P <0.01). The first visit to hypertensive patients in the experimental group was significantly shorter than the control group (P <0.05). There was no significant difference in the length of hospital stay between the two groups (P> 0.05). The total cost of hospitalization, examination fees, medical expenses and medical costs of hypertensive patients in the experimental group were significantly lower than those in the control group (P <0.05). Satisfaction degree of service attitude of medical staffs, satisfaction degree of diagnosis and treatment techniques, satisfaction degree of referral effect and satisfaction degree of medical expenses with those of the control group in experimental group were significantly higher than those in control group (P < 0.05). Conclusions The clinical pathway of bidirectional referral has an impact on the rate of re-visit, the time of first visit, the length of stay, the cost of medical treatment and the degree of satisfaction of patients with hypertensive patients. It has good social and economic benefits and is a feasible and effective clinical pathway.