目的:将临床路径实施效果评价指标体系应用于自然临产阴道分娩病种,验证此指标体系的科学性和实用性.方法:共抽取9家医院862例自然临产阴道分娩患者,分为临床路径组(n=496)和对照组(n=366).临床路径组根据自然临产阴道分娩临床路径流程进行诊疗,对照组采用常规方法进行诊疗,应用临床路径实施效果评价指标体系对临床路径实施效果进行评价.结果:临床路径组住院天数、术前住院天数、住院费用等15个评价指标均优于对照组(P＜0.05),体现了实施临床路径的优越性;综合评价结果显示:不同等级(二级医院、三级医院),不同性质(专科医院,综合医院)的临床路径组综合评分均高于对应等级和性质的对照组,且二级医院临床路径组综合评分(Ci=0.7967)高于三级医院临床路径组(Ci=0.2033),综合医院临床路径组(Ci=0.8948)高于专科医院临床路径组(Ci=0.1052).结论:临床路径实施效果评价指标体系能将各医院临床路径实施效果量化,进行医院之间的比较,为临床路径的管理提供了参考依据,值得推广使用.%Objective:In order to apply the index system for clinical evaluation of implementation effect in hospitals.Methods:A total of 862 patients with vaginal delivery from 9 hospitals were randomly divided into an clinical pathway group (n=496) and a control group (n=366).The patients in the control group received traditional treatment procedure while the patients in the clinical pathway group experienced procedure of the clinical treatment.The index system was used for clinical evaluation of implementation effect.Results:There were obvious advantages in 15 indicators in the clinical pathway group than those in the control group (P＜0.05).The comprehensive score of the clinical pathway group was higher than the control group of the corresponding grade and nature of the hospital.The comprehensive score for secondary hospitals (Ci=0.7967) were higher than that for the tertiary hospitals (Ci=0.2033).The comprehensive score for the general hospitals (Ci=0.8948) were higher than that for the specialized hospitals (Ci=0.1052).As for clinical implementation effect,the secondary hospitals were better than the tertiary hospital,and the general hospitals were better than the specialized hospitals.Conclusion:The index system for clinical evaluation could quantify the implementation effect,and compare the implementation effect in different hospitals,which provides reference for the management of clinical pathway.
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