Kelly C S, Andersen C L, Pestian J P, Wenger A D, Finch A B, Strope G L, Luckstead E F
Department of Pediatrics, Eastern Virginia Medical School, Children's Hospital of The King's Daughter, Norfolk 23507, USA.
Ann Allergy Asthma Immunol. 2000 May;84(5):509-16. doi: 10.1016/S1081-1206(10)62514-8.
Although asthma clinical pathways are used with increasing frequency, few controlled studies have evaluated the clinical and cost effectiveness of these pathways.
To evaluate the effect of an inpatient asthma clinical pathway on cost and quality of care for children with asthma.
One hundred forty-nine children were treated for status asthmaticus using an asthma clinical pathway in a children's hospital between September and December 1997. Thirty-four of 149 children treated with the clinical pathway were randomly selected. A retrospective cohort control group of non-pathway patients (N = 34) was matched with each pathway patient by age, race, gender, co-morbidities, asthma severity score, ICU admission, and time of year admitted. Differences between the two groups in length of stay, total costs, readmission rate, inpatient management, and discharge medications were compared.
Length of stay was significantly lower in the clinical pathway group compared with the control group (36 hours versus 71 hours, P < .001) and total costs decreased significantly ($1685 versus $2829, P < .001) as a result of the pathway. Asthmatic children on the clinical pathway were significantly more likely than the control group to complete asthma teaching while hospitalized (65% versus 18%, P < .001), to be discharged with a prescription for a controller medication (88% versus 53%, P < .01), and to have a peak flow meter (57% versus 23%, P < .05) and a spacer device (100% versus 71%, P < .001) for home use.
Implementation of this inpatient clinical pathway led to a decrease in length of stay and a reduction in total cost while improving quality of care for hospitalized asthmatic children.
尽管哮喘临床路径的使用频率日益增加，但很少有对照研究评估这些路径的临床和成本效益。
评估住院哮喘临床路径对哮喘患儿护理成本和质量的影响。
1997年9月至12月期间，一家儿童医院使用哮喘临床路径对149名哮喘持续状态患儿进行了治疗。从149名接受临床路径治疗的患儿中随机选取34名。通过年龄、种族、性别、合并症、哮喘严重程度评分、重症监护病房（ICU）入住情况和入院时间，为每名路径治疗患儿匹配一组回顾性队列对照组非路径治疗患者（N = 34）。比较两组在住院时间、总成本、再入院率、住院管理和出院用药方面的差异。
临床路径组的住院时间显著低于对照组（36小时对71小时，P <.001），并且由于该路径，总成本显著降低（1685美元对2829美元，P <.001）。接受临床路径治疗的哮喘患儿在住院期间完成哮喘教学的可能性显著高于对照组（65%对18%，P <.001），出院时开具控制药物处方的可能性更高（88%对53%，P <.01），并且拥有家用峰流速仪（57%对23%，P <.05）和储雾罐（100%对71%，P <.001）。
实施该住院临床路径可缩短住院时间、降低总成本，同时提高住院哮喘患儿的护理质量。
