腦梗塞病患實施臨床路徑之成效探討

Outcome of the Clinical Pathway for Cerebral Infarction

本研究的目的為建立住院腦梗塞患者之臨床路徑，並以病患平均住院天數、健保醫療費用、病患滿意度來評值腦梗塞臨床路徑實施的成效。本研究將實施臨床路徑後的個案與實施路徑前同一診斷電腦資料庫中的個案資料做比較，觀察臨床路徑實施前後病患的住院日數與醫療費用、返急診率與再住院率以評值臨床路徑的效果。臨床路徑實施後共收案63人，臨床路徑實施前共收案58人，兩組病患基本屬性的同質性很高，本研究發現在實施臨床路徑後，腦梗塞患者平均住院天數由實施前的17.6天縮短至12.9天，下降26.7%，平均住院費用（健保）自66,675元降至52,291元，下降21.6%。多數個案均能於14天內完成全部治療與護理，且對醫師與護理的服務及衛教內容感到滿意及很滿意，腦梗塞患者超出臨床路徑預定之住院天數原因為梗塞部位大，又有其他診斷需同時控制，或無法在預期時間完成全部檢查，或等待轉送至療養機構的時間太長。未來遇到有次診斷或無法通過臨床路徑者，應該納入個案管理繼續追縱照護。

The purposes of this study were (1) to develop a clinical pathway for the clients with cerebral infarction; (2) to evaluate the outcome of clinical pathway for the client's average hospitalized day, medical fee and satisfaction. We evaluated the outcome of the clinical pathway with retrospective data collected during 5 months prior to implementation by comparing average hospitalized day, medical fee, emergency return rate, and readmission rate.The clinical pathway group was composed of 63 persons, while the retrospective group 58. These two group homogeneity was fairly high. We observed after using the clinical pathway, the hospitalized day of clients reduced by 26.7%(from 17.6 days to 12.9 days). and the average medical fee reduced by 12.6%(from NT$66,675 to NT$52,291). Most clients finished the whole treatment and nursing care within 14days and were satisfied with the service and health education of doctors and nurses. Some clients stayed longer than expected because the lesion of cerebral infarction was too large and/or with other subdiagnosis needing to be controlled. In other cases the clinents had to wait to be transferred into other long-term care institutions.It is concluded that the practice of clinical pathway effectively reduced medical fee and hospital stay. Meanwhile, patients with concomitant subdiagnosis or those who can not go through the clinical pathway due to various reasons should be cared by case management.