Huang Xiaoqin, Fan Chunqiu, Jia Jianping, Wang Lihong, Li Xiaoying, Wu Yingfeng, Deng Yingmei, Wu Jian
From the Dept. of Neurology, Xuan Wu Hospital, Capital Medical University, Beijing, China (XH, CF, JJ, LW, JW); Dept. of Medical Affair, Xuan Wu Hospital, Capital Medical University, Beijing, China (XL, YW); and Medical Records and Statistic Office, Xuan Wu Hospital, Capital Medical University, Beijing, China (YD).
J Neuropsychiatry Clin Neurosci. 2014 Fall;26(4):386-91. doi: 10.1176/appi.neuropsych.13070171.
Clinical pathway (CP) of transient ischemic attack (TIA) is an interdisciplinary, comprehensive, standardized management model for medical care of TIA. It aims to standardize the procedure, reduce the cost, and improve the quality of medical care. However, its effect is still unclear.
To evaluate the effect of TIA CP and provide evidence for control of medical care cost, optimize the structure of hospital cost, and make best use of medical resource.
112 patients in the CP group and 179 patients in the nonclinical pathway (NCP) group were included in this nonconcurrent cohort study.
The average length of stay was 9.55 ± 3.89 days in the NCP group, and it was 7.26 ± 2.09 days in the CP group. The average length of stay was significantly shortened by 2.29 days. Hospital cost in the CP group significantly increased by 7.9% (868 yuan) compared with that in the NCP group. The proportion of medication cost significantly decreased by 5%, while the proportion of examination cost significantly increased by 8%. As for the clinical outcomes of patients with TIA, 98.21% of the patients in the CP group were discharged in a good condition, while the proportion was 97.77% in the NCP group, and no significant difference was found between the improvement rate of the two groups. Eight patients (4%) in the NCP group were admitted to the hospital because of a 30-day recurrent TIA or cerebral infarction; four of them had cerebral infarction, whereas no recurrent TIA or cerebral infarction was found in the CP group at the 30-day follow-up.
Implementation of TIA CP could reduce the length of stay, the proportion of medication cost, and optimize the structure of hospital expense, thus making best use of medical resources and improve the quality of TIA medical care.
短暂性脑缺血发作（TIA）临床路径是一种针对TIA医疗护理的跨学科、综合、标准化管理模式。其目的是规范诊疗程序、降低成本并提高医疗质量。然而，其效果仍不明确。
评估TIA临床路径的效果，为控制医疗成本、优化医院成本结构及充分利用医疗资源提供依据。
本非同期队列研究纳入了临床路径组的112例患者和非临床路径（NCP）组的179例患者。
NCP组平均住院时间为9.55±3.89天，临床路径组为7.26±2.09天。平均住院时间显著缩短了2.29天。与NCP组相比，临床路径组的住院费用显著增加了7.9%（868元）。药品费用比例显著下降了5%，而检查费用比例显著增加了8%。至于TIA患者的临床结局，临床路径组98.21%的患者康复出院，NCP组这一比例为97.77%，两组改善率之间未发现显著差异。NCP组有8例患者（4%）因30天内TIA复发或脑梗死再次入院；其中4例发生脑梗死，而临床路径组在30天随访时未发现TIA复发或脑梗死。
实施TIA临床路径可缩短住院时间、降低药品费用比例并优化医院费用结构，从而充分利用医疗资源并提高TIA医疗质量。
