慢性心力衰竭中西医结合临床路径多中心实施效果研究

目的评估慢性心力衰竭中西医结合临床路径多中心实施的效益。方法采用非同期历史对照研究与同期临床对照研究相结合的方法，全国4家医院实施临床路径规范化管理后，评估其对患者住院天数、住院费用、临床疗效、患者满意度、生活质量的影响。结果非同期历史对照研究结果表明：路径组较回顾组住院天数明显缩短（12.59 天 vs 18.44 天），住院总费用明显降低（9 051.90 元 vs 11 978.40 元），差异有统计学意义（P<0.05）；路径组与回顾组心功能疗效比较，路径组显效率和总有效率均高于回顾组（45.60% vs 21.90%，96.80% vs 86.10%），差异有统计学意义（P<0.01）。同期对照研究表明路径组与常规组的住院天数（11.19 天 vs 13.21 天）比较，差异有统计学意义（P<0.05）；路径组平均住院总费用低于常规组（8 656.80 元 vs 11 609.70 元），差异有统计学意义（P<0.01）；两组中医证候疗效比较，路径组总有效率高于回顾组（97.10% vs 93.62%），差异有统计学意义（P<0.05）；路径组与常规组心功能疗效比较路径组显效率高于常规组（49.30% vs 38.30%），差异有统计学意义（P<0.05）；路径组整体满意度高于常规组，差异有统计学意义（P<0.01）。两组患者出院后3个月内的病死率、因心衰发作再次入院率比较，差异无统计学意义（P>0.05），生活质量比较差异有统计学意义（P<0.05）。结论该临床路径能够缩短住院时间，降低住院费用，提高临床疗效，提高患者生活质量，提高患者满意度，可供全国推广应用。

英文摘要:

ObjectiveTo assess a multi center study effectiveness of clinical pathways based on integrative medicine （IM） for chronic heart failure （CHF） patients. MethodsA combined method of historical control study and clinical study on concurrent control was used. After the standard management for clinical pathways was carried out in four hospitals at home， the effects on hospitalization days， medical expenses， clinical efficacy， patient satisfaction， and quality of life were assessed. ResultsResults of non concurrent historical control study showed that： the hospital stay was significantly shorter in the pathways group than in the retrospective group （12.59 days vs 18.44 days）， and the total cost of hospitalization was significantly reduced in the pathways group （￥9 051.90 vs ￥11 978.40）， showing statistical difference （P<0.01）. Moreover， the effect on the heart function was better in the pathways group than in the retrospective group （the markedly effective rate： 45.60% vs 21.90%； the total effective rate： 96.80% vs 86.10%）， showing statistical difference （P<0.01）. Results of clinical study on concurrent control showed that the hospital stay was significantly shorter in the pathways group than in the control group （11.19 days vs 13.21 days）， showing statistical difference （P<0.05）. The average total cost of hospitalization was significantly lower in the pathways group than in the control group （￥8 656.80 vs ￥11 609.70）， showing statistical difference （P<0.01）. As for clinical efficacy of Chinese medical syndrome， the total effective rate was higher in the pathways group than in the control group （97.10% vs 93.62%）， showing statistical difference （P<0.05）. The markedly effective rate of heart function was better in the pathways group than in the control group， showing statistical difference （49.30% vs 38.30%， P<0.05）. The overall satisfaction was higher in the pathways group than in the conventional group （P<0.01）. There was no statistical difference in the mortality within 3 months after discharge from hospital， and the readmission rate due to heart failure between the two groups （P>0.05）. But there was statistical difference in the quality of life （P<0.05）. Conclusion The pathway could shorten the hospitalization time， decrease the cost of hospitalization， improve the clinical efficacy， improve patients′ quality of life and satisfaction， therefore， it could be spread nationwide.

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