Pfau Patrick R, Cooper Gregory S, Carlson Mark D, Chak Amitabh, Sivak Michael V, Gonet Judith A, Boyd Karen K, Wong Richard C K
Division of Gastroenterology, Department of Medicine, Quality Center, University Hospitals of Cleveland, Case Western Reserve University, Cleveland, Ohio 44106-5066, USA.
Am J Gastroenterol. 2004 Mar;99(3):425-31. doi: 10.1111/j.1572-0241.2004.04090.x.
Acute nonvariceal upper gastrointestinal (GI) bleeding is the most common medical emergency encountered by gastroenterologists resulting in high patient morbidity and cost. We sought to establish if a GI bleeding clinical care pathway could improve the quality and cost effectiveness of inpatient medical care.
A disease management program for acute upper GI bleeding was established. Length of stay, time to endoscopy, utilization of potentially unnecessary radiological tests, acid suppression, and cost of care were compared between patients pre- and postinitiation of GI bleeding pathway guidelines.
The instituted GI bleeding management program significantly reduced the use of intravenous H2-blockade from 65.3% to 47.7% (p = 0.002). The use of radiological tests, time to endoscopy, and length of hospital of stay were unchanged. There was a trend toward a reduction in total cost and variable direct cost per patient admitted with acute upper GI bleeding, from $5,381 to $4,627 and from $2,269 to $1,952, respectively.
A clinical care pathway may affect the management of acute upper GI bleeding and reduce costs. However, there are significant limitations and barriers to the overall effectiveness of such a pathway in actual clinical practice.
急性非静脉曲张性上消化道（GI）出血是胃肠病学家遇到的最常见的医疗急症，会导致患者高发病率和高成本。我们试图确定GI出血临床护理路径是否可以提高住院医疗护理的质量和成本效益。
建立了急性上消化道出血疾病管理项目。比较了GI出血路径指南实施前后患者的住院时间、内镜检查时间、潜在不必要的放射学检查的使用、抑酸情况及护理成本。
实施的GI出血管理项目显著降低了静脉使用H2阻滞剂的比例，从65.3%降至47.7%（p = 0.002）。放射学检查的使用、内镜检查时间和住院时间没有变化。急性上消化道出血患者的总费用和可变直接费用有下降趋势，分别从5381美元降至4627美元，从2269美元降至1952美元。
临床护理路径可能会影响急性上消化道出血的管理并降低成本。然而，在实际临床实践中，这样一条路径的整体有效性存在显著局限性和障碍。
